Provider Demographics
NPI:1700125853
Name:LEROY-DESIR, MARIE CARMEL (OTR)
Entity Type:Individual
Prefix:MRS
First Name:MARIE CARMEL
Middle Name:
Last Name:LEROY-DESIR
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MRS
Other - First Name:MARIE CARMEL
Other - Middle Name:
Other - Last Name:DESIR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR
Mailing Address - Street 1:21167 VIA VENTURA
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-2231
Mailing Address - Country:US
Mailing Address - Phone:970-988-0984
Mailing Address - Fax:
Practice Address - Street 1:7000 W PALMETTO PARK RD STE 210
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-3430
Practice Address - Country:US
Practice Address - Phone:561-409-4490
Practice Address - Fax:565-447-8190
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-10
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL77950225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist