Healthcare Provider Details

I. General information

NPI: 1730355371
Provider Name (Legal Business Name): AUDREY PALMER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2008
Last Update Date: 05/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 S WINCHESTER BLVD SUITE 5
SAN JOSE CA
95128-2901
US

IV. Provider business mailing address

21110 LOCUST DR
LOS GATOS CA
95033-8637
US

V. Phone/Fax

Practice location:
  • Phone: 408-241-7033
  • Fax: 408-241-7027
Mailing address:
  • Phone: 408-353-4149
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT 5204
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: