Provider Demographics
NPI:1952528697
Name:GERVIN, ANN P (MT-BC)
Entity Type:Individual
Prefix:MRS
First Name:ANN
Middle Name:P
Last Name:GERVIN
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3612 CRESTSIDE RD
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35223-1515
Mailing Address - Country:US
Mailing Address - Phone:205-969-3857
Mailing Address - Fax:
Practice Address - Street 1:3800 RIDGEWAY DR
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-5506
Practice Address - Country:US
Practice Address - Phone:205-868-2066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL225A00000XOtherMUSIC THERAPY