Provider Demographics
NPI:1487287702
Name:MOLIERE, JESSIE (OTR/MS)
Entity type:Individual
Prefix:
First Name:JESSIE
Middle Name:
Last Name:MOLIERE
Suffix:
Gender:F
Credentials:OTR/MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13574 VILLAGE PARK DR STE 205
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32837-7694
Mailing Address - Country:US
Mailing Address - Phone:407-789-7777
Mailing Address - Fax:321-300-1054
Practice Address - Street 1:13574 VILLAGE PARK DR STE 205
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32837-7694
Practice Address - Country:US
Practice Address - Phone:407-789-7777
Practice Address - Fax:321-300-1054
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-14
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT14694225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty