Healthcare Provider Details

I. General information

NPI: 1730025875
Provider Name (Legal Business Name): A WILLIAM KERMAVNER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

808 DEBORAH DR
WILLOWICK OH
44095-4317
US

IV. Provider business mailing address

808 DEBORAH DR
WILLOWICK OH
44095-4317
US

V. Phone/Fax

Practice location:
  • Phone: 440-585-7841
  • Fax:
Mailing address:
  • Phone: 440-585-7841
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number22564917
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: