Provider Demographics
NPI:1740479690
Name:PALMER, ANTHONY DALE (MOT)
Entity type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:DALE
Last Name:PALMER
Suffix:
Gender:M
Credentials:MOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 SW 37TH AVE
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33312-4220
Mailing Address - Country:US
Mailing Address - Phone:954-581-5492
Mailing Address - Fax:954-693-9861
Practice Address - Street 1:1950 SW 37TH AVE
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33312-4220
Practice Address - Country:US
Practice Address - Phone:954-581-5492
Practice Address - Fax:954-693-9861
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-16
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT8428225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE7449ZMedicare UPIN