Provider Demographics
NPI:1306236229
Name:PALMER, KANDRA LEE (OTA)
Entity type:Individual
Prefix:
First Name:KANDRA
Middle Name:LEE
Last Name:PALMER
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6215 5TH ST
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32968-9654
Mailing Address - Country:US
Mailing Address - Phone:603-558-0265
Mailing Address - Fax:
Practice Address - Street 1:10827 SW STONY CREEK WAY
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34987-2746
Practice Address - Country:US
Practice Address - Phone:772-345-4960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-30
Last Update Date:2015-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL13685224Z00000X
NH0109224Z00000X
VT073.0097969224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant