Provider Demographics
NPI:1003212689
Name:PALMER, LINDA (OTR)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:PALMER
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 CHURCH LN
Mailing Address - Street 2:
Mailing Address - City:VILLA RICA
Mailing Address - State:GA
Mailing Address - Zip Code:30180-4720
Mailing Address - Country:US
Mailing Address - Phone:770-459-6533
Mailing Address - Fax:678-666-5565
Practice Address - Street 1:2001 CHURCH LN
Practice Address - Street 2:
Practice Address - City:VILLA RICA
Practice Address - State:GA
Practice Address - Zip Code:30180-4720
Practice Address - Country:US
Practice Address - Phone:770-459-6533
Practice Address - Fax:678-666-5565
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-10
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT001661225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics