MEDICARE: DOUGLAS PALMER CRC, CDMS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225C00000X	Rehabilitation Counselor	15763	IL

General Provider Information

NPI Number	:	1548048382
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOUGLAS PALMER CRC, CDMS

Provider Business Mailing Address
First Line	:	440 E SWEDESFORD RD STE 2045
Second Line	:
City	:	WAYNE
State	:	PA
Zip	:	19087-1842
Country	:	US
Telephone Number	:	207-303-4598
Fax Number	:	888-741-9222

Provider Business Practice Location Address
First Line	:	440 E SWEDESFORD RD STE 2045
Second Line	:
City	:	WAYNE
State	:	PA
Zip	:	19087-1842
Country	:	US
Telephone Number	:	207-303-4598
Fax Number	:	888-741-9222

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/21/2023
Last Update Date	:	09/21/2023

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