Provider Demographics
NPI:1851187025
Name:STEWART, PEYTON SHEA
Entity type:Individual
Prefix:
First Name:PEYTON
Middle Name:SHEA
Last Name:STEWART
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:PEYTON
Other - Middle Name:SHEA
Other - Last Name:CALDWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2305 OLD KENTUCKY RD
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:TN
Mailing Address - Zip Code:38583-5208
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2305 OLD KENTUCKY RD
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:TN
Practice Address - Zip Code:38583-5208
Practice Address - Country:US
Practice Address - Phone:931-239-4373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-15
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6008225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist