Provider Demographics
NPI:1811353378
Name:PALM, GEORGE ALAN JR (OTR)
Entity type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:ALAN
Last Name:PALM
Suffix:JR
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2406 E ASHBY RD
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-8962
Mailing Address - Country:US
Mailing Address - Phone:989-600-0035
Mailing Address - Fax:
Practice Address - Street 1:2406 E ASHBY RD
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-8962
Practice Address - Country:US
Practice Address - Phone:989-600-0035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-13
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101134225X00000X
FLOT16863225X00000X
IN31006248A225X00000X
OHOT009574225X00000X
MI5201001447225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist