Healthcare Provider Details

I. General information

NPI: 1255006847
Provider Name (Legal Business Name): REBECCA PEYTON TAYLOR WILSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REBECCA TAYLOR WILSON

II. Dates (important events)

Enumeration Date: 08/16/2021
Last Update Date: 08/16/2021
Certification Date: 08/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8706 S US HIGHWAY 25
CORBIN KY
40701-4974
US

IV. Provider business mailing address

401 CHERRY ST APT 3
LONDON KY
40741-1498
US

V. Phone/Fax

Practice location:
  • Phone: 606-677-1166
  • Fax:
Mailing address:
  • Phone: 606-627-2008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: