{
"Npi": {
"NPI": "1023371523",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "SHEALYTHERAPEUTICS",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "2432 OLD DOUGLASS RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "WINNSBORO",
"MailingAddressStateName": "SC",
"MailingAddressPostalCode": "29180-7799",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "864-923-5339",
"MailingAddressFaxNumber": "185-527-1460",
"FirstLinePracticeLocationAddress": "2432 OLD DOUGLASS RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "WINNSBORO",
"PracticeLocationAddressStateName": "SC",
"PracticeLocationAddressPostalCode": "29180-7799",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "864-923-5339",
"PracticeLocationAddressFaxNumber": "185-527-1460",
"EnumerationDate": "06/19/2012",
"LastUpdateDate": "06/19/2012",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SHEALY",
"AuthorizedOfficialFirstName": "DONNA",
"AuthorizedOfficialMiddleName": "DENISE",
"AuthorizedOfficialTitle": "OCCUPATIONAL THERAPIST/OWNER",
"AuthorizedOfficialNamePrefix": "MRS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "LPN, OTR",
"AuthorizedOfficialTelephoneNumber": "864-923-5339",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "174400000X",
"TaxonomyName": "Specialist",
"LicenseNumber": "2695",
"LicenseNumberStateCode": "SC",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
}
}
}