Provider Demographics
NPI:1720819816
Name:MCMILLON, PEYTON NICOLE
Entity type:Individual
Prefix:
First Name:PEYTON
Middle Name:NICOLE
Last Name:MCMILLON
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 1:934 ALBANY ST
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79605-3939
Mailing Address - Country:US
Mailing Address - Phone:325-267-0617
Mailing Address - Fax:
Practice Address - Street 1:5526 BUFFALO GAP RD
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79606-4126
Practice Address - Country:US
Practice Address - Phone:325-216-9555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-09
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX123661225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist