{
"Npi": {
"NPI": "1013493519",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "BRIDGE",
"FirstName": "ALEXA",
"MiddleName": "JADE",
"NamePrefix": "MRS.",
"NameSuffix": null,
"Credential": "MS, OTR/L",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "SHAFFER",
"OtherFirstName": "ALEXA",
"OtherMiddleName": "JADE",
"OtherNamePrefix": "MISS",
"OtherNameSuffix": null,
"OtherCredential": "MS, OTR/L",
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "PO BOX 6",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "WALSTON",
"MailingAddressStateName": "PA",
"MailingAddressPostalCode": "15781-0006",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "814-952-6911",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1464 N MAIN ST STE 14",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "PUNXSUTAWNEY",
"PracticeLocationAddressStateName": "PA",
"PracticeLocationAddressPostalCode": "15767-2609",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "814-249-7028",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "07/17/2018",
"LastUpdateDate": "09/16/2020",
"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": "225X00000X",
"TaxonomyName": "Occupational Therapist",
"LicenseNumber": "OC015736",
"LicenseNumberStateCode": "PA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}