Provider Demographics
NPI:1528462116
Name:PALMER, GERARD E (OTR/L)
Entity type:Individual
Prefix:
First Name:GERARD
Middle Name:E
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 1:4490 MARSH HARBOR DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:TAVARES
Mailing Address - State:FL
Mailing Address - Zip Code:32778-4752
Mailing Address - Country:US
Mailing Address - Phone:407-301-4256
Mailing Address - Fax:
Practice Address - Street 1:4490 MARSH HARBOR DR
Practice Address - Street 2:SUITE 101
Practice Address - City:TAVARES
Practice Address - State:FL
Practice Address - Zip Code:32778-4752
Practice Address - Country:US
Practice Address - Phone:407-301-4256
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-10
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT10301174400000X, 225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation
No174400000XOther Service ProvidersSpecialist