Healthcare Provider Details

I. General information

NPI: 1063377521
Provider Name (Legal Business Name): CHARRYSE C PALMER
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 POST OFFICE RD
WALDORF MD
20602-2713
US

IV. Provider business mailing address

11304 GOLDEN EAGLE PL
WALDORF MD
20603-5990
US

V. Phone/Fax

Practice location:
  • Phone: 301-870-4277
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberM04908
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: