Provider Demographics
NPI:1174172779
Name:MUSGROVE, SIERRA R (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:SIERRA
Middle Name:R
Last Name:MUSGROVE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5603
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32314-5603
Mailing Address - Country:US
Mailing Address - Phone:850-345-4412
Mailing Address - Fax:
Practice Address - Street 1:4501 W SHANNON LAKES DR APT 301
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32309-4200
Practice Address - Country:US
Practice Address - Phone:850-273-4579
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-05
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT19474225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist