Mirage Mariah Sanders, OTD, OTR/L

Primary specialty

Pediatric Occupational TherapistTaxonomy code 225XP0200X

License

OT009323 Issued in GA

Practice address

3160 Main St Ste 103
Duluth, GA 30096-3461

Phone

(678) 404-7744

NPI assigned

Sep 23, 2024

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1727049600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727740800000",
    "number": "1033936976",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3005 LAKESIDE CIR",
            "city": "COVINGTON",
            "state": "GA",
            "postal_code": "300168852",
            "telephone_number": "470-435-5629"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3160 MAIN ST STE 103",
            "city": "DULUTH",
            "state": "GA",
            "postal_code": "300963461",
            "telephone_number": "678-404-7744"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3005 Lakeside Cir",
            "address_purpose": "LOCATION",
            "city": "Covington",
            "state": "GA",
            "postal_code": "300168852",
            "country_code": "US",
            "telephone_number": "470-435-5629",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SANDERS",
        "first_name": "MIRAGE",
        "middle_name": "MARIAH",
        "name_prefix": "Dr.",
        "credential": "OTD, OTR/L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-09-23",
        "last_updated": "2024-10-01",
        "certification_date": "2024-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225XP0200X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Pediatrics",
            "state": "GA",
            "license": "OT009323",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Pediatric Occupational Therapist in Duluth, GA
• Providers in Duluth, GA by specialty
• Pediatric Occupational Therapist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.