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General NPI Number Information
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NPI Number | 1356726434
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Entity Type | Individual
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Provider Name | MR. RILEY PALMER III
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Gender | Male
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Dates
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Enumeration Date | 07/30/2015
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Last Update Date | 11/09/2018
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Provider Practice Location Address
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Address Line | 350 E LA CANADA BLVD
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City | AVONDALE
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State | AZ
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Zip | 85323-1643
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Country | US
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Telephone | 623-932-2282
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Fax |
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Provider Business Mailing Address
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Address Line | 350 E LA CANADA BLVD
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City | AVONDALE
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State | AZ
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Zip | 85323-1643
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Country | US
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Telephone | 623-932-2282
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 5201008278
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 15-0587
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License Number State | NV
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Taxonomy #3
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OTH-006694
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License Number State | AZ
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