MEDICARE: KERFIE DESVARIEUX

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251C00000X	Developmentally Disabled Services Day Training Agency

General Provider Information

NPI Number	:	1255737607
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KERFIE DESVARIEUX

Provider Business Mailing Address
First Line	:	1714 SARAZEN DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32808-6148
Country	:	US
Telephone Number	:	407-309-0856
Fax Number	:

Provider Business Practice Location Address
First Line	:	1332 44TH ST
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32839-1229
Country	:	US
Telephone Number	:	407-309-0856
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/12/2014
Last Update Date	:	11/12/2014

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Directions to “ KERFIE DESVARIEUX ” Practice Location

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