Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | OT.0005045 | CO |
Y | 225XP0200X | Occupational Therapist - Pediatrics | OT.0005045 | CO |
NPI | 1043740343 |
---|---|
Provider Name | Maureen Palmer |
First Address | Fort Collins, CO 80522-0210 |
Second Address | Brea, CA 92821-4747 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2017 |
Last Update Date | 19/06/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
NA | NA (01) | CO |