Provider Demographics
NPI:1922544790
Name:PAYNE, CHARITY LYNNE WRIGHT (CTRS, TRS)
Entity type:Individual
Prefix:
First Name:CHARITY
Middle Name:LYNNE WRIGHT
Last Name:PAYNE
Suffix:
Gender:F
Credentials:CTRS, TRS
Other - Prefix:
Other - First Name:CHARITY
Other - Middle Name:LYNNE
Other - Last Name:WRIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1065 N 1620 W APT 54
Mailing Address - Street 2:
Mailing Address - City:SAINT GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-5468
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:178 S 1200 E
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-5508
Practice Address - Country:US
Practice Address - Phone:435-688-1207
Practice Address - Fax:435-634-5546
Is Sole Proprietor?:No
Enumeration Date:2017-01-17
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8678686-4002225800000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator