Individual provider Active NPI

Dava M Anderson-Poeck, OT

  • Occupational Therapist
  • Fishers, IN
National Provider Identifier
1861590549
Registry record updated May 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
Practice address
11570 E 126TH St
Fishers, IN 46037-9592
Phone
(317) 579-0166
NPI assigned
Sep 20, 2006
Last updated
May 20, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 20, 2024

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 NU Primary

Addresses

Primary practice location

11570 E 126TH St
Fishers, IN 46037-9592

Mailing address

4381 Weather Stone Xing
Zionsville, IN 46077-8576
Phone (832) 715-1387

Other identifiers 1

IdentifierTypeStateIssuer
157569801MedicaidTX

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)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Creative Health Care Management LLC Occupational Therapist CurrentSince Jun 1, 2024 Accepting new patients
Creative Health Care Management LLC Occupational Therapist CurrentSince Jun 1, 2024 Accepting new patients

Locations

11570 E 126th St
Fishers, IN 46037
Phone (317) 349-5913

300 E Washington Blvd
Fort Wayne, IN 46802
Phone (260) 422-5511

3630 Hickory Rd
Mishawaka, IN 46545
Phone (574) 252-7225

10 S 9th St
Ste 4
Noblesville, IN 46060

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1716163200000",
    "number": "1861590549",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4381 WEATHER STONE XING",
            "city": "ZIONSVILLE",
            "state": "IN",
            "postal_code": "460778576",
            "telephone_number": "832-715-1387"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11570 E 126TH ST",
            "city": "FISHERS",
            "state": "IN",
            "postal_code": "460379592",
            "telephone_number": "317-579-0166"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERSON-POECK",
        "first_name": "DAVA",
        "middle_name": "M",
        "credential": "OT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-20",
        "last_updated": "2024-05-20",
        "certification_date": "2024-05-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "157569801",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fishers, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 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.