MEDICARE: MRS. KERRY ANN KAVANAUGH BA, RBT

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	RBT-16-16355
2	106S00000X	Behavior Technician	16-16355	FL
3	222Q00000X	Developmental Therapist
4	106S00000X	Behavior Technician	RBT-16-16355	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1861828311
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KERRY ANN KAVANAUGH BA, RBT

Provider Business Mailing Address
First Line	:	6416 NW 5TH WAY
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33309-6112
Country	:	US
Telephone Number	:	888-754-0398
Fax Number	:

Provider Business Practice Location Address
First Line	:	6416 NW 5TH WAY
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33309-6112
Country	:	US
Telephone Number	:	888-754-0398
Fax Number	:

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

Provider Enumeration Date	:	09/16/2013
Last Update Date	:	10/27/2019

Similar Medicare Providers

1588208649 — CIERRO KENNEDY
Practice Location Address:

6416 NW 5TH WAY
FORT LAUDERDALE, FL
33309-6112

Practice Phone: 888-754-0398
Practice Fax:

1467560680 — MORNING STAR REHAB INC
Practice Location Address:

6460 NW 5TH WAY
FT LAUDERDALE, FL
33309-6112

Practice Phone: 954-834-2222
Practice Fax:

1811192214 — DESTINATION HOPE
Practice Location Address:

6460 NW 5TH WAY , SUITES 6458, 6456, 6454
FORT LAUDERDALE, FL
33309-6112

Practice Phone: 954-771-2091
Practice Fax: 954-771-2098

1861676157 — DISTINCTIVE HOME CARE, LLC
Practice Location Address:

6460 NW 5TH WAY
FT LAUDERDALE, FL
33309-6112

Practice Phone: 954-727-9142
Practice Fax: 954-727-2825

1811339526 — JESSICA MIRET
Practice Location Address:

6416 NW 5TH WAY
FORT LAUDERDALE, FL
33309-6112

Practice Phone: 888-754-0398
Practice Fax:

1194118505 — ALLISON TAYLOR-STAPLES
Practice Location Address:

6416 NW 5TH WAY
FORT LAUDERDALE, FL
33309-6112

Practice Phone: 888-754-0398
Practice Fax:

Directions to “ MRS. KERRY ANN KAVANAUGH BA, RBT” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.