Individual
CANDICE HAIRSTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5408 OREY AVE, CLEVELAND, OH 44105-3339
(216) 240-4690
Mailing address
3831 LEE HEIGHTS BLVD, CLEVELAND, OH 44128-1635
Taxonomy
Speciality
Code
Description
License number
State
261QR0400X
Rehabilitation Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
86-3010133
STATE OF OHIO
OH
Enumeration date
09/12/2022
Last updated
09/12/2022
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