MEDICARE: CECIL CHRIS HONAKER III O.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	OTR853	AR

General Provider Information

NPI Number	:	1407963267
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CECIL CHRIS HONAKER III O.T.

Provider Business Mailing Address
First Line	:	PO BOX 3528
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72913-3528
Country	:	US
Telephone Number	:	479-274-2000
Fax Number	:	479-274-2194

Provider Business Practice Location Address
First Line	:	4300 REGIONS PARK DR
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72916-9373
Country	:	US
Telephone Number	:	479-274-6300
Fax Number	:	479-484-4664

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/25/2006
Last Update Date	:	02/10/2016

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