Provider Demographics
NPI:1780404566
Name:BELCHER, TIERRA (C/OTA)
Entity type:Individual
Prefix:
First Name:TIERRA
Middle Name:
Last Name:BELCHER
Suffix:
Gender:F
Credentials:C/OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6601 CHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32217-2252
Mailing Address - Country:US
Mailing Address - Phone:904-636-0313
Mailing Address - Fax:904-367-0021
Practice Address - Street 1:6535 CHESTER AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32217-2247
Practice Address - Country:US
Practice Address - Phone:904-731-8230
Practice Address - Fax:904-367-0021
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-15
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOAT20068224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant