{
"Npi": {
"NPI": "1003429150",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "SMITH",
"FirstName": "MACKENNA",
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": "PTA, OTR/L",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "BUTLER",
"OtherFirstName": "MACKENNA",
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "178 LAYMAN RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "TRENTON",
"MailingAddressStateName": "TN",
"MailingAddressPostalCode": "38382-9762",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "731-618-2114",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "109 COMMERCE ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "PARIS",
"PracticeLocationAddressStateName": "TN",
"PracticeLocationAddressPostalCode": "38242-4917",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "731-336-7352",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "08/28/2020",
"LastUpdateDate": "09/22/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "225200000X",
"TaxonomyName": "Physical Therapy Assistant",
"LicenseNumber": "7475",
"LicenseNumberStateCode": "TN",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "225X00000X",
"TaxonomyName": "Occupational Therapist",
"LicenseNumber": "8465",
"LicenseNumberStateCode": "TN",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}