Healthcare Provider Details

I. General information

NPI: 1235727157
Provider Name (Legal Business Name): PEYTON CARPENTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2021
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

907 OUTER RD
ORLANDO FL
32814-6601
US

IV. Provider business mailing address

65 LEGENDARY DR APT 303
TITUSVILLE FL
32780-7344
US

V. Phone/Fax

Practice location:
  • Phone: 855-832-6727
  • Fax:
Mailing address:
  • Phone: 321-313-9533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-21-150373
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: