Provider Demographics
NPI:1891833976
Name:PALMQUIST, JOLENE (OTR)
Entity Type:Individual
Prefix:
First Name:JOLENE
Middle Name:
Last Name:PALMQUIST
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 1:9568 LAWRENECE 2077
Mailing Address - Street 2:
Mailing Address - City:MT.VERNON
Mailing Address - State:MO
Mailing Address - Zip Code:65712
Mailing Address - Country:US
Mailing Address - Phone:417-452-2028
Mailing Address - Fax:
Practice Address - Street 1:801 N LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:MONETT
Practice Address - State:MO
Practice Address - Zip Code:65708-1641
Practice Address - Country:US
Practice Address - Phone:417-236-2480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO001007225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist