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General NPI Number Information
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NPI Number | 1104079870
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Entity Type | Organization
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Legal Business Name | HONOR THERAPY SERVICES, LLC
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Dates
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Enumeration Date | 10/28/2008
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Last Update Date | 11/15/2011
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Provider Practice Location Address
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Address Line | 1308 BARLOW DR
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City | UTICA
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State | MS
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Zip | 39175-9423
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Country | US
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Telephone | 601-624-2043
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Fax | 601-885-2060
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Provider Business Mailing Address
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Address Line | PO BOX 91
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City | UTICA
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State | MS
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Zip | 39175-0091
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Country | US
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Telephone | 601-624-2043
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Fax | 601-885-2060
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Authorized Official
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Title or Position | OWNER/SOLE PROPRIETOR
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Name | MS. SHARON KAY BANKS
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Credential | OTR/L
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Telephone | 601-624-2043
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD1600X
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Taxonomy Name | Developmental Disabilities Clinic/Center
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License Number | OT0346
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License Number State | MS
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