Healthcare Provider Details

I. General information

NPI: 1114831260
Provider Name (Legal Business Name): TALLY A PALMER LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1519 S RESERVE ST
MISSOULA MT
59801-4755
US

IV. Provider business mailing address

1519 S RESERVE ST
MISSOULA MT
59801-4755
US

V. Phone/Fax

Practice location:
  • Phone: 406-549-2006
  • Fax: 406-549-6574
Mailing address:
  • Phone: 406-549-2006
  • Fax: 406-549-6574

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number22894
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: