Healthcare Provider Details

I. General information

NPI: 1962328799
Provider Name (Legal Business Name): PAYTON JADE STEWART
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3350 W 7800 S
WEST JORDAN UT
84088-4506
US

IV. Provider business mailing address

360 S STATE ST UNIT E304
OREM UT
84058-5706
US

V. Phone/Fax

Practice location:
  • Phone: 801-282-0686
  • Fax:
Mailing address:
  • Phone: 308-289-7065
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225800000X
TaxonomyRecreation Therapist
License Number49544364001
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: