MEDICARE: MR. DAVIS MONTGOMERY PALMER OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	2805	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215247457
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DAVIS MONTGOMERY PALMER OTR/L

Provider Business Mailing Address
First Line	:	959 SHIP WRECK PL
Second Line	:
City	:	INMAN
State	:	SC
Zip	:	29349-7264
Country	:	US
Telephone Number	:	864-884-7530
Fax Number	:

Provider Business Practice Location Address
First Line	:	2 GRIFFITH RD
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29607-3503
Country	:	US
Telephone Number	:	864-276-8583
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/20/2010
Last Update Date	:	01/18/2021

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