Basic Information
| Provider Information | |||||||||
| NPI: | 1841886744 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PALMER | ||||||||
| FirstName: | KELLIE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | OTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10 VIRGINIA LN | ||||||||
| Address2: | |||||||||
| City: | GOSHEN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 109245508 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9088925542 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 51-55 N ROUTE 9W | ||||||||
| Address2: | |||||||||
| City: | WEST HAVERSTRAW | ||||||||
| State: | NY | ||||||||
| PostalCode: | 109931195 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8457864000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/15/2020 | ||||||||
| LastUpdateDate: | 12/15/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/15/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 022323-01 | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.