Provider Demographics
NPI:1407963267
Name:HONAKER, CECIL CHRIS III (OT)
Entity Type:Individual
Prefix:
First Name:CECIL
Middle Name:CHRIS
Last Name:HONAKER
Suffix:III
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3528
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72913-3528
Mailing Address - Country:US
Mailing Address - Phone:479-274-2000
Mailing Address - Fax:479-274-2194
Practice Address - Street 1:4300 REGIONS PARK DR
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72916-9373
Practice Address - Country:US
Practice Address - Phone:479-274-6300
Practice Address - Fax:479-484-4664
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR853225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5A2326718Medicare PIN
AR0384730021Medicare NSC