Provider Demographics
NPI:1083169155
Name:PALMER, ERICA J (OTR)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:J
Last Name:PALMER
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:ERICA
Other - Middle Name:
Other - Last Name:REEP
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR
Mailing Address - Street 1:2563 PINWHERRY ST NW
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32907-6845
Mailing Address - Country:US
Mailing Address - Phone:715-509-0139
Mailing Address - Fax:
Practice Address - Street 1:902 BUCHANAN RD
Practice Address - Street 2:
Practice Address - City:NEW TAZEWELL
Practice Address - State:TN
Practice Address - Zip Code:37825-7410
Practice Address - Country:US
Practice Address - Phone:423-626-8215
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-18
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist