Healthcare Provider Details

I. General information

NPI: 1326914060
Provider Name (Legal Business Name): ELIZABETH A PAYNE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2025
Last Update Date: 10/10/2025
Certification Date: 10/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1551 SUGARLAND DR
SHERIDAN WY
82801-5721
US

IV. Provider business mailing address

8804 SHADOWLAKE WAY
SPRINGFIELD VA
22153-2100
US

V. Phone/Fax

Practice location:
  • Phone: 307-674-5575
  • Fax:
Mailing address:
  • Phone: 703-839-3492
  • Fax: 703-839-3492

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT-1519
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: