MEDICARE: PEYTON K WILLIAMS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician	19-108163	OK
2	106S00000X	Behavior Technician	19-100953	OK

General Provider Information

NPI Number	:	1861030124
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PEYTON K WILLIAMS

Provider Business Mailing Address
First Line	:	13404 N MERIDIAN AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73120-8311
Country	:	US
Telephone Number	:	405-752-2264
Fax Number	:

Provider Business Practice Location Address
First Line	:	5024 N GROVE AVE
Second Line	:
City	:	WARR ACRES
State	:	OK
Zip	:	73122-5119
Country	:	US
Telephone Number	:	405-752-2264
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/18/2019
Last Update Date	:	12/18/2019

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Directions to “ PEYTON K WILLIAMS ” Practice Location

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