Provider Demographics
NPI:1154660272
Name:PALMER, ELIZABETH RACHAEL
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:RACHAEL
Last Name:PALMER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1786 E NEIL CIR
Mailing Address - Street 2:APT 2
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-8240
Mailing Address - Country:US
Mailing Address - Phone:978-902-1367
Mailing Address - Fax:
Practice Address - Street 1:1786 E NEIL CIR
Practice Address - Street 2:APT 2
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-8240
Practice Address - Country:US
Practice Address - Phone:978-902-1367
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-08
Last Update Date:2013-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1966225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist