Healthcare Provider Details

I. General information

NPI: 1366263568
Provider Name (Legal Business Name): PEYTON JEAN DYE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2024
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

354 COUNTY ROAD 65
ADA OH
45810-9762
US

IV. Provider business mailing address

354 COUNTY ROAD 65
ADA OH
45810-9762
US

V. Phone/Fax

Practice location:
  • Phone: 567-674-8786
  • Fax:
Mailing address:
  • Phone: 567-674-8786
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberVJ548210
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: