Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | OT001661 | GA |
NPI | 1003212689 |
---|---|
Provider Name | Linda Palmer |
First Address | Villa Rica, GA 30180-4720 |
Second Address | Villa Rica, GA 30180-4720 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/11/2014 |
Last Update Date | 10/11/2014 |