Provider Demographics
NPI:1073158457
Name:BENTON-HAMILTON, PAYTON JANE
Entity Type:Individual
Prefix:
First Name:PAYTON
Middle Name:JANE
Last Name:BENTON-HAMILTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:PAYTON
Other - Middle Name:JANE
Other - Last Name:BENTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:89 TILL ST
Mailing Address - Street 2:
Mailing Address - City:ENFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06082-2032
Mailing Address - Country:US
Mailing Address - Phone:860-878-0435
Mailing Address - Fax:
Practice Address - Street 1:345A GREENWOOD ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01607-1753
Practice Address - Country:US
Practice Address - Phone:508-363-0200
Practice Address - Fax:508-363-1213
Is Sole Proprietor?:No
Enumeration Date:2019-11-09
Last Update Date:2019-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist