Healthcare Provider Details

I. General information

NPI: 1144929217
Provider Name (Legal Business Name): MOTES PERFORMANCE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2023
Last Update Date: 02/28/2023
Certification Date: 02/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136 DARTMOORE DR
CLARKSVILLE TN
37043-7428
US

IV. Provider business mailing address

136 DARTMOORE DR
CLARKSVILLE TN
37043-7428
US

V. Phone/Fax

Practice location:
  • Phone: 706-988-5512
  • Fax:
Mailing address:
  • Phone: 706-988-5512
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171R00000X
TaxonomyInterpreter
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: DAVID LANIER MOTES
Title or Position: DIRECTOR
Credential: BCBA
Phone: 706-988-5512