Healthcare Provider Details

I. General information

NPI: 1679951172
Provider Name (Legal Business Name): MRS. MEREDITH PALMER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2015
Last Update Date: 05/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 QUAIL VIEW RDG
CLEVELAND GA
30528-9211
US

IV. Provider business mailing address

9 QUAIL VIEW RDG
CLEVELAND GA
30528-9211
US

V. Phone/Fax

Practice location:
  • Phone: 678-936-2815
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT006185
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: