Provider Demographics
NPI:1730355371
Name:PALMER, AUDREY
Entity type:Individual
Prefix:
First Name:AUDREY
Middle Name:
Last Name:PALMER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21110 LOCUST DR
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95033-8637
Mailing Address - Country:US
Mailing Address - Phone:408-353-4149
Mailing Address - Fax:
Practice Address - Street 1:900 S WINCHESTER BLVD
Practice Address - Street 2:SUITE 5
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-2901
Practice Address - Country:US
Practice Address - Phone:408-241-7033
Practice Address - Fax:408-241-7027
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-04
Last Update Date:2008-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT 5204225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics