Basic Information
| Provider Information | |||||||||
| NPI: | 1073158457 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BENTON-HAMILTON | ||||||||
| FirstName: | PAYTON | ||||||||
| MiddleName: | JANE | ||||||||
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| OtherLastName: | BENTON | ||||||||
| OtherFirstName: | PAYTON | ||||||||
| OtherMiddleName: | JANE | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 89 TILL ST | ||||||||
| Address2: | |||||||||
| City: | ENFIELD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060822032 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8608780435 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 345A GREENWOOD ST | ||||||||
| Address2: | |||||||||
| City: | WORCESTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 016071753 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5083630200 | ||||||||
| FaxNumber: | 5083631213 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/09/2019 | ||||||||
| LastUpdateDate: | 11/09/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 222Q00000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Developmental Therapist |
No ID Information.