Provider Demographics
NPI:1952537722
Name:ERVIN, NAKEIA BRADLEY (OTR/L, MHA)
Entity Type:Individual
Prefix:MRS
First Name:NAKEIA
Middle Name:BRADLEY
Last Name:ERVIN
Suffix:
Gender:F
Credentials:OTR/L, MHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19106-4518
Mailing Address - Country:US
Mailing Address - Phone:800-974-6383
Mailing Address - Fax:800-974-4241
Practice Address - Street 1:215 CHURCH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19106-4518
Practice Address - Country:US
Practice Address - Phone:800-974-6383
Practice Address - Fax:800-974-4241
Is Sole Proprietor?:No
Enumeration Date:2009-06-06
Last Update Date:2009-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC010750225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist