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General NPI Number Information
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NPI Number | 1578045449
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Entity Type | Individual
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Provider Name | MAYCELIN PALKER
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Gender | Female
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Dates
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Enumeration Date | 09/06/2018
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Last Update Date | 05/28/2025
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Provider Practice Location Address
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Address Line | 950 SW 18TH AVE
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City | FORT LAUDERDALE
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State | FL
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Zip | 33312-3260
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Country | US
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Telephone | 407-461-0730
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Fax |
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Provider Business Mailing Address
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Address Line | 9061 SW 122ND AVE APT 306
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City | MIAMI
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State | FL
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Zip | 33186-2066
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Country | US
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Telephone | 407-461-0730
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State | FL
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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 | 23947
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License Number State | FL
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Legacy Identifiers
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Identifier #1
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Identifier Code | 117387900
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Identifier Type | MEDICAID
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Identifier State | FL
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Identifier Issuer | Florida Medicaid Provider ID
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Proprietary Identifiers Ever Reported
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Identifier #1
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Identifier Code | 117387900
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Identifier Type | MEDICAID
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Identifier State | FL
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Identifier Issuer | Florida Medicaid Provider ID
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