=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023203759
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DAVID LYNN HAIRSTON O.T.R.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/06/2007
-----------------------------------------------------
Last Update Date | 12/04/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6010 W AMARILLO BLVD SUITE 4515
-----------------------------------------------------
City | AMARILLO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79106-1990
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 806-355-9703
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6010 W AMARILLO BLVD SUITE 4515
-----------------------------------------------------
City | AMARILLO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79106-1990
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 806-355-9703
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | 103827
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------