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General NPI Number Information
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NPI Number | 1235190455
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Entity Type | Individual
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Provider Name | JASON L. PALMER A.T.C.
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Gender | Male
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Dates
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Enumeration Date | 03/29/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 501 W MARYLAND ST
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City | INDIANAPOLIS
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State | IN
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Zip | 46225-1041
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Country | US
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Telephone | 317-269-3542
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Fax |
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Provider Business Mailing Address
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Address Line | 49 W BIRCH ST
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City | CANTON
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State | IL
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Zip | 61520-1238
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Country | US
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Telephone | 309-647-1437
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 96002019
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License Number State | IL
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