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General NPI Number Information
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NPI Number | 1902322068
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Entity Type | Organization
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Legal Business Name | WESSON THERAPY SERVICES, LLC
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Dates
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Enumeration Date | 08/20/2017
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Last Update Date | 08/20/2017
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Provider Practice Location Address
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Address Line | 1101 E 12TH ST
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City | CORINTH
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State | MS
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Zip | 38834-2658
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Country | US
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Telephone | 662-872-9156
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Fax |
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Provider Business Mailing Address
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Address Line | 1101 E 12TH ST
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City | CORINTH
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State | MS
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Zip | 38834-2658
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER, OCCUPATIONAL THERAPIST
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Name | ELLEN WESSON
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Credential | OTR/L, CHT
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Telephone | 662-872-9156
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | OT2500
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License Number State | MS
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