Provider Demographics
NPI:1699015198
Name:PALMER, JOSEPHINE C (COTA/L BBA)
Entity Type:Individual
Prefix:
First Name:JOSEPHINE
Middle Name:C
Last Name:PALMER
Suffix:
Gender:F
Credentials:COTA/L BBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10596 TWIN RIVERS RD APT B1
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-2113
Mailing Address - Country:US
Mailing Address - Phone:240-354-9711
Mailing Address - Fax:
Practice Address - Street 1:10596 TWIN RIVERS RD APT B1
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-2113
Practice Address - Country:US
Practice Address - Phone:240-354-9711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-20
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDP-456-440-112-640224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDP-456-440-112-640OtherSTATE LICENSE