Healthcare Provider Details

I. General information

NPI: 1902322068
Provider Name (Legal Business Name): WESSON THERAPY SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2017
Last Update Date: 08/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 E 12TH ST
CORINTH MS
38834-2658
US

IV. Provider business mailing address

1101 E 12TH ST
CORINTH MS
38834-2658
US

V. Phone/Fax

Practice location:
  • Phone: 662-872-9156
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT2500
License Number StateMS

VIII. Authorized Official

Name: ELLEN WESSON
Title or Position: OWNER, OCCUPATIONAL THERAPIST
Credential: OTR/L, CHT
Phone: 662-872-9156