Provider Demographics
NPI:1124309000
Name:CERVANTES, ANN RACHEL (OTR)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:RACHEL
Last Name:CERVANTES
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:ANN
Other - Middle Name:RACHEL
Other - Last Name:WILLIAMS REETZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:817 MAIN ST NE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55413-1931
Mailing Address - Country:US
Mailing Address - Phone:612-362-2418
Mailing Address - Fax:
Practice Address - Street 1:817 MAIN ST NE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55413-1931
Practice Address - Country:US
Practice Address - Phone:612-362-2418
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-06
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN102581225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist