Individual
RENATA LEVON HAIRSTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
320 HOSPITAL DR, MARTINSVILLE, VA 24112-1900
(276) 666-7590
Mailing address
202 AMY AVE, MARTINSVILLE, VA 24112-2602
(240) 418-6909
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
0131000360
VA
Other
Enumeration date
06/01/2009
Last updated
06/01/2009
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