MEDICARE: KATHLEEN J DESIR

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	106S00000X	Behavior Technician		FL

General Provider Information

NPI Number	:	1477479467
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN J DESIR

Provider Business Mailing Address
First Line	:	101 OCEAN BREEZE CIR
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33435-3700
Country	:	US
Telephone Number	:	747-206-9876
Fax Number	:

Provider Business Practice Location Address
First Line	:	7301A W PALMETTO PARK RD STE 100C
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33433-3403
Country	:	US
Telephone Number	:	954-248-1171
Fax Number	:

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

Provider Enumeration Date	:	06/25/2026
Last Update Date	:	06/25/2026

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