Healthcare Provider Details

I. General information

NPI: 1770771602
Provider Name (Legal Business Name): CENTERS OF DEVELOPMENT, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2007
Last Update Date: 03/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1080 NEAL ST SUITE 300
COOKEVILLE TN
38501-0942
US

IV. Provider business mailing address

1080 NEAL ST SUITE 300
COOKEVILLE TN
38501-0942
US

V. Phone/Fax

Practice location:
  • Phone: 931-372-2567
  • Fax: 931-372-2572
Mailing address:
  • Phone: 931-372-2567
  • Fax: 931-372-2572

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT1594
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License NumberPT1594
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License NumberPT1594
License Number StateTN
# 4
Primary TaxonomyN
Taxonomy Code225XN1300X
TaxonomyNeurorehabilitation Occupational Therapist
License NumberOT2435
License Number StateTN
# 5
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT2435
License Number StateTN
# 6
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP3418
License Number StateTN
# 7
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT2435
License Number StateTN

VIII. Authorized Official

Name: DR. JASON C CLOPTON
Title or Position: OWNER
Credential: O.D.
Phone: 931-372-2567