Healthcare Provider Details

I. General information

NPI: 1881102689
Provider Name (Legal Business Name): CORY KLEPPE RBT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2018
Last Update Date: 01/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9038 CROSS PARK DR STE 105
KNOXVILLE TN
37923-4720
US

IV. Provider business mailing address

9038 CROSS PARK DR STE 105
KNOXVILLE TN
37923-4720
US

V. Phone/Fax

Practice location:
  • Phone: 865-394-6612
  • Fax: 865-315-7014
Mailing address:
  • Phone: 865-394-6612
  • Fax: 865-315-7014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-17-46057
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: