Provider Demographics
NPI:1982019428
Name:PALMER, ASHLEY RAE (MATRG)
Entity Type:Individual
Prefix:MS
First Name:ASHLEY
Middle Name:RAE
Last Name:PALMER
Suffix:
Gender:F
Credentials:MATRG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4792 HALDEN RD
Mailing Address - Street 2:
Mailing Address - City:FLOODWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55736-8544
Mailing Address - Country:US
Mailing Address - Phone:218-391-3089
Mailing Address - Fax:
Practice Address - Street 1:2016 S 6TH ST
Practice Address - Street 2:
Practice Address - City:BRAINERD
Practice Address - State:MN
Practice Address - Zip Code:56401-4529
Practice Address - Country:US
Practice Address - Phone:218-828-7375
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-24
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN25132255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer