Provider Demographics
NPI:1316974355
Name:CLEVELAND, JEREMY D (ATC)
Entity type:Individual
Prefix:MR
First Name:JEREMY
Middle Name:D
Last Name:CLEVELAND
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 OHARA DR
Mailing Address - Street 2:
Mailing Address - City:ALBERTVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35950-2596
Mailing Address - Country:US
Mailing Address - Phone:256-302-6525
Mailing Address - Fax:256-593-8281
Practice Address - Street 1:206 OHARA DR
Practice Address - Street 2:
Practice Address - City:ALBERTVILLE
Practice Address - State:AL
Practice Address - Zip Code:35950-2596
Practice Address - Country:US
Practice Address - Phone:256-302-6525
Practice Address - Fax:256-593-8281
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer