Provider Demographics
NPI:1285931311
Name:PALMER, ANGELA B (COTA/L)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:B
Last Name:PALMER
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:ANGIE
Other - Middle Name:B
Other - Last Name:PALMER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:COTA/L
Mailing Address - Street 1:2206 RIDGE CREST LN
Mailing Address - Street 2:
Mailing Address - City:MOUNT AIRY
Mailing Address - State:NC
Mailing Address - Zip Code:27030-2483
Mailing Address - Country:US
Mailing Address - Phone:336-786-2664
Mailing Address - Fax:
Practice Address - Street 1:2206 RIDGE CREST LN
Practice Address - Street 2:
Practice Address - City:MOUNT AIRY
Practice Address - State:NC
Practice Address - Zip Code:27030-2483
Practice Address - Country:US
Practice Address - Phone:336-786-2664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-25
Last Update Date:2011-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4463224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant