Provider Demographics
NPI:1093054330
Name:MOMPLAISIR, TIERRA S (OTR)
Entity Type:Individual
Prefix:MRS
First Name:TIERRA
Middle Name:S
Last Name:MOMPLAISIR
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MS
Other - First Name:TIERRA
Other - Middle Name:
Other - Last Name:ROBINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:206 RIDGEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33510-4617
Mailing Address - Country:US
Mailing Address - Phone:863-802-3800
Mailing Address - Fax:863-802-0480
Practice Address - Street 1:206 RIDGEWOOD AVE PEDIATRIC THERAPY SERVICES
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33510-4617
Practice Address - Country:US
Practice Address - Phone:813-662-1060
Practice Address - Fax:813-662-0530
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-06
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT15602225XP0200X
FLOTT15602225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL008332400Medicaid
FLOTT15602OtherFLORIDA OT LICENSE