Provider Demographics
NPI:1467093401
Name:CLINE, JEREMIAH M (OTR/L)
Entity Type:Individual
Prefix:MR
First Name:JEREMIAH
Middle Name:M
Last Name:CLINE
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3012 CALTON HL
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37664-5783
Mailing Address - Country:US
Mailing Address - Phone:903-724-9541
Mailing Address - Fax:
Practice Address - Street 1:377 CLONCE ST
Practice Address - Street 2:
Practice Address - City:WEBER CITY
Practice Address - State:VA
Practice Address - Zip Code:24290-7269
Practice Address - Country:US
Practice Address - Phone:276-477-5640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-01
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119007866225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist