Provider Demographics
NPI:1841886744
Name:PALMER, KELLIE (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:KELLIE
Middle Name:
Last Name:PALMER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 VIRGINIA LN
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:NY
Mailing Address - Zip Code:10924-5508
Mailing Address - Country:US
Mailing Address - Phone:908-892-5542
Mailing Address - Fax:
Practice Address - Street 1:51-55 N ROUTE 9W
Practice Address - Street 2:
Practice Address - City:WEST HAVERSTRAW
Practice Address - State:NY
Practice Address - Zip Code:10993-1195
Practice Address - Country:US
Practice Address - Phone:845-786-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-15
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022323-01225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist