Individual provider Active NPI

Niaja Dace, OTR/L

  • Occupational Therapist
  • Atlanta, GA
National Provider Identifier
1043753510
Registry record updated Nov 30, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
OT005820 Issued in GA
Practice address
530 Piedmont Ave NE
905
Atlanta, GA 30308-4415
Phone
(850) 585-0069
NPI assigned
Nov 30, 2016
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 30, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapist 225X00000X OT005820 GA Primary

Addresses

Primary practice location

530 Piedmont Ave NE
905
Atlanta, GA 30308-4415

Mailing address

530 Piedmont Ave NE
905
Atlanta, GA 30308-4415
Phone (850) 585-0069

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190626002596 GA Practitioner - Occupational Therapist in Private Practice 1153655030 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
OT005820GAMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Dove Rehab, LLC CurrentSince Apr 21, 2019 Accepting new patients

Locations

9 Sherwood Ln SE
Marietta, GA 30067
Phone (404) 642-5497

4455 Lower Roswell Rd
Unit 683641
Marietta, GA 30068

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1480464000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1480464000000",
    "number": "1043753510",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "530 PIEDMONT AVE NE",
            "address_2": "905",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303084415",
            "telephone_number": "850-585-0069"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "530 PIEDMONT AVE NE",
            "address_2": "905",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303084415",
            "telephone_number": "850-585-0069"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DACE",
        "first_name": "NIAJA",
        "credential": "OTR/L",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-11-30",
        "last_updated": "2016-11-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "GA",
            "license": "OT005820",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Atlanta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.