Provider Demographics
NPI:1417834417
Name:PALMER, SUSIE (LICENSED MASSAGE THE)
Entity type:Individual
Prefix:
First Name:SUSIE
Middle Name:
Last Name:PALMER
Suffix:
Gender:F
Credentials:LICENSED MASSAGE THE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 RYAN AVE
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:DE
Mailing Address - Zip Code:19720-1325
Mailing Address - Country:US
Mailing Address - Phone:302-607-1473
Mailing Address - Fax:
Practice Address - Street 1:707 FOULK RD STE 102
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19803-3737
Practice Address - Country:US
Practice Address - Phone:302-332-1932
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-20
Last Update Date:2025-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225700000X
DEMT-0004193225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist