Provider Demographics
NPI:1104653419
Name:WORSHAM, PEYTON FAITH
Entity type:Individual
Prefix:
First Name:PEYTON
Middle Name:FAITH
Last Name:WORSHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 WALDEN XING
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31216-7552
Mailing Address - Country:US
Mailing Address - Phone:478-731-4745
Mailing Address - Fax:
Practice Address - Street 1:243 HOLLYWOOD BLVD NW
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32548-4783
Practice Address - Country:US
Practice Address - Phone:850-601-9133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-19
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist