Provider Demographics
NPI:1811889306
Name:GERBER, MAYCIE ANNA
Entity type:Individual
Prefix:
First Name:MAYCIE
Middle Name:ANNA
Last Name:GERBER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8171 N IRON HORSE DR
Mailing Address - Street 2:
Mailing Address - City:LAKE POINT
Mailing Address - State:UT
Mailing Address - Zip Code:84074-3496
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8171 N IRON HORSE DR
Practice Address - Street 2:
Practice Address - City:LAKE POINT
Practice Address - State:UT
Practice Address - Zip Code:84074-3496
Practice Address - Country:US
Practice Address - Phone:801-227-9333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-17
Last Update Date:2025-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13455363-4002225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist