Provider Demographics
NPI:1013931955
Name:PALMER, MAUREEN ELIZABETH (OTR, CIMT)
Entity type:Individual
Prefix:MRS
First Name:MAUREEN
Middle Name:ELIZABETH
Last Name:PALMER
Suffix:
Gender:F
Credentials:OTR, CIMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38062 ROSS ST
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-4865
Mailing Address - Country:US
Mailing Address - Phone:734-462-8447
Mailing Address - Fax:734-542-9947
Practice Address - Street 1:25811 W 12 MILE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1896
Practice Address - Country:US
Practice Address - Phone:248-356-7415
Practice Address - Fax:248-356-7416
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMP000744225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI7506643OtherAETNA