Provider Demographics
NPI:1124692413
Name:HINES, CHANDON LEIGH (MSOTR/L)
Entity type:Individual
Prefix:
First Name:CHANDON
Middle Name:LEIGH
Last Name:HINES
Suffix:
Gender:F
Credentials:MSOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 COUNTY ROAD 34
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35634-4404
Mailing Address - Country:US
Mailing Address - Phone:256-856-7196
Mailing Address - Fax:
Practice Address - Street 1:4890 UNIVERSITY SQ STE 7
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35816-1896
Practice Address - Country:US
Practice Address - Phone:256-837-2470
Practice Address - Fax:256-837-2471
Is Sole Proprietor?:No
Enumeration Date:2021-05-19
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics