Provider Demographics
NPI:1639289077
Name:WEST TENNESSEE CEREBRAL PALSY ASSOCIATION
Entity Type:Organization
Organization Name:WEST TENNESSEE CEREBRAL PALSY ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:M
Authorized Official - Last Name:PRESCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:731-668-3322
Mailing Address - Street 1:34 GARLAND DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-3654
Mailing Address - Country:US
Mailing Address - Phone:731-668-3322
Mailing Address - Fax:731-664-2992
Practice Address - Street 1:34 GARLAND DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-3654
Practice Address - Country:US
Practice Address - Phone:731-668-3322
Practice Address - Fax:731-664-2992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPSS00000001102251P0200X, 225XP0200X, 235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty
Not Answered225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
Not Answered235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN117255OtherUNISON
TN13886OtherTLC
TN30997OtherBCBS TENNESSEE SELECT
TN446656Medicaid
TN0446656Medicare ID - Type Unspecified