Provider Demographics
NPI:1730515438
Name:HAIRSTON, PAMELA (COTA/L)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:HAIRSTON
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 BALINT DR
Mailing Address - Street 2:229
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10710-3941
Mailing Address - Country:US
Mailing Address - Phone:718-601-4526
Mailing Address - Fax:
Practice Address - Street 1:7 BALINT DR
Practice Address - Street 2:229
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10710-3941
Practice Address - Country:US
Practice Address - Phone:718-601-4526
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-25
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005548-1224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant