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Individual

MRS. TIERRA S MOMPLAISIR

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
OTR

Contact information

Practice address
206 RIDGEWOOD AVE PEDIATRIC THERAPY SERVICES, BRANDON, FL 33510-4617
(813) 662-1060
(813) 662-0530
Mailing address
206 RIDGEWOOD AVE, BRANDON, FL 33510-4617
(863) 802-3800
(863) 802-0480

Taxonomy

Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
OT15602
FL
225XP0200X
Pediatric Occupational Therapist
OTT15602
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
008332400
FL
01
OTT15602
FLORIDA OT LICENSE
FL
Enumeration date
02/06/2013
Last updated
05/31/2018
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