Provider Demographics
NPI:1689063521
Name:PALMER, LAURA MARTIN (OTR, CHT)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:MARTIN
Last Name:PALMER
Suffix:
Gender:F
Credentials:OTR, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3050 N LITCHFIELD RD
Mailing Address - Street 2:STE100
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85395-7804
Mailing Address - Country:US
Mailing Address - Phone:623-935-5505
Mailing Address - Fax:623-935-5551
Practice Address - Street 1:3050 N LITCHFIELD RD
Practice Address - Street 2:STE100
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-7804
Practice Address - Country:US
Practice Address - Phone:623-935-5505
Practice Address - Fax:623-935-5551
Is Sole Proprietor?:No
Enumeration Date:2015-01-15
Last Update Date:2015-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6173225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand