Provider Demographics
NPI:1255006847
Name:WILSON, REBECCA PEYTON TAYLOR
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:PEYTON TAYLOR
Last Name:WILSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:TAYLOR
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:401 CHERRY ST APT 3
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40741-1498
Mailing Address - Country:US
Mailing Address - Phone:606-627-2008
Mailing Address - Fax:
Practice Address - Street 1:8706 S US HIGHWAY 25
Practice Address - Street 2:
Practice Address - City:CORBIN
Practice Address - State:KY
Practice Address - Zip Code:40701-4974
Practice Address - Country:US
Practice Address - Phone:606-677-1166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-16
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist