Individual
STACY BANES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
101 MILLS ST, BROOKHAVEN, MS 39601-2521
(601) 823-5567
Mailing address
4109 HIGHWAY 98 W, SUMMIT, MS 39666-9132
(601) 279-6390
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT0367
MS
Other
Enumeration date
05/17/2007
Last updated
12/29/2009
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