Provider Demographics
NPI:1356726434
Name:PALMER, RILEY III
Entity type:Individual
Prefix:MR
First Name:RILEY
Middle Name:
Last Name:PALMER
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 E LA CANADA BLVD
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85323-1643
Mailing Address - Country:US
Mailing Address - Phone:623-932-2282
Mailing Address - Fax:
Practice Address - Street 1:350 E LA CANADA BLVD
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85323-1643
Practice Address - Country:US
Practice Address - Phone:623-932-2282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-30
Last Update Date:2018-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201008278225X00000X
NV15-0587225X00000X
AZOTH-006694225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist