Provider Demographics
NPI:1407673577
Name:WILSON, PEYTON NANCE (MOT, OTR/L)
Entity type:Individual
Prefix:
First Name:PEYTON
Middle Name:NANCE
Last Name:WILSON
Suffix:
Gender:F
Credentials:MOT, OTR/L
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 8209
Mailing Address - Street 2:
Mailing Address - City:LANDIS
Mailing Address - State:NC
Mailing Address - Zip Code:28088-8209
Mailing Address - Country:US
Mailing Address - Phone:704-360-3900
Mailing Address - Fax:704-360-3900
Practice Address - Street 1:2036 QUILL CT
Practice Address - Street 2:
Practice Address - City:KANNAPOLIS
Practice Address - State:NC
Practice Address - Zip Code:28083-6298
Practice Address - Country:US
Practice Address - Phone:704-360-3900
Practice Address - Fax:704-360-3900
Is Sole Proprietor?:No
Enumeration Date:2024-09-20
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC17199225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist