Individual
TRICIA KISIDAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS OTR/L
Contact information
Practice address
538 N LECANTO HWY, SUITE 538, LECANTO, FL 34461-8547
(352) 746-3300
Mailing address
1450 VILLA CAPRI CIR, APT 111, ODESSA, FL 33556-6089
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
OT 14102
FL
Other
Enumeration date
09/02/2010
Last updated
09/02/2010
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