Provider Demographics
NPI:1083833610
Name:HAIRSTON, RITA M (COTA)
Entity Type:Individual
Prefix:
First Name:RITA
Middle Name:M
Last Name:HAIRSTON
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:2211 MERCK DR
Mailing Address - Street 2:APT 204
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-3180
Mailing Address - Country:US
Mailing Address - Phone:336-923-5208
Mailing Address - Fax:
Practice Address - Street 1:5755 SHATTOLIN DR
Practice Address - Street 2:
Practice Address - City:WINSTON-SALEM
Practice Address - State:NC
Practice Address - Zip Code:27105
Practice Address - Country:US
Practice Address - Phone:336-744-2779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2009-05-04
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant