Active NPI
Dejanira Breona Mallory, OTR
- Occupational Therapist
- Dallas, TX
National Provider Identifier
1700468618
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 121494
- Practice address
- 8550 Cadenza LN
Dallas, TX 75228-4923 - Phone
- (214) 328-4309
- NPI assigned
- Apr 21, 2021
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 121494 | TX | Primary |
Addresses
Primary practice location
8550 Cadenza LN
Dallas, TX 75228-4923
Mailing address
5350 Amesbury Dr Apt 315
Dallas, TX 75206-3408
Phone (682) 556-6964
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 121494 | TX | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dallas Center, Inc. | Occupational Therapist | Past | Accepting new patients |
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.
-
- Developmental Disabilities Clinic/Center
- Dallas, TX
- NPI 1245304211
Occupational Therapist
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1618963200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1618963200000",
"number": "1700468618",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5350 AMESBURY DR APT 315",
"city": "DALLAS",
"state": "TX",
"postal_code": "752063408",
"telephone_number": "682-556-6964"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8550 CADENZA LN",
"city": "DALLAS",
"state": "TX",
"postal_code": "752284923",
"telephone_number": "214-328-4309"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MALLORY",
"first_name": "DEJANIRA",
"middle_name": "BREONA",
"name_prefix": "Mrs.",
"credential": "OTR",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-04-21",
"last_updated": "2021-04-21",
"certification_date": "2021-04-21",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "TX",
"license": "121494",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dallas, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.