Provider Demographics
NPI:1215247457
Name:PALMER, DAVIS MONTGOMERY (OTR/L)
Entity type:Individual
Prefix:MR
First Name:DAVIS
Middle Name:MONTGOMERY
Last Name:PALMER
Suffix:
Gender:M
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 1:959 SHIP WRECK PL
Mailing Address - Street 2:
Mailing Address - City:INMAN
Mailing Address - State:SC
Mailing Address - Zip Code:29349-7264
Mailing Address - Country:US
Mailing Address - Phone:864-884-7530
Mailing Address - Fax:
Practice Address - Street 1:2 GRIFFITH RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-3503
Practice Address - Country:US
Practice Address - Phone:864-276-8583
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-20
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2805225X00000X, 225X00000X
225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCTH4433Medicaid
NC3401322Medicaid