Healthcare Provider Details

I. General information

NPI: 1104079870
Provider Name (Legal Business Name): HONOR THERAPY SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2008
Last Update Date: 11/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1308 BARLOW DR
UTICA MS
39175-9423
US

IV. Provider business mailing address

PO BOX 91
UTICA MS
39175-0091
US

V. Phone/Fax

Practice location:
  • Phone: 601-624-2043
  • Fax: 601-885-2060
Mailing address:
  • Phone: 601-624-2043
  • Fax: 601-885-2060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License NumberOT0346
License Number StateMS

VIII. Authorized Official

Name: MS. SHARON KAY BANKS
Title or Position: OWNER/SOLE PROPRIETOR
Credential: OTR/L
Phone: 601-624-2043