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1043556756 NPI number — SHAWNA PENELOPE VASQUEZ OTR/L

NPI Number: 1043556756
Health Care Provider/Practitioner: SHAWNA PENELOPE VASQUEZ OTR/L

Information about “1043556756” NPI (SHAWNA PENELOPE VASQUEZ OTR/L) exists in 1043556756 in HTML format HTML  |  1043556756 in plain Text format TXT  |  1043556756 in PDF (Portable Document Format) PDF  |  1043556756 in an XML format XML  formats.

NPI Number : 1043556756 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1043556756",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "VASQUEZ",
    "FirstName": "SHAWNA",
    "MiddleName": "PENELOPE",
    "NamePrefix": "MISS",
    "NameSuffix": null,
    "Credential": "OTR/L",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "1425 MACKINAC AVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SOUTH MILWAUKEE",
    "MailingAddressStateName": "WI",
    "MailingAddressPostalCode": "53172-3043",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "262-215-3279",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1425 MACKINAC AVE",
    "SecondLinePracticeLocationAddress": "APT # 501",
    "PracticeLocationAddressCityName": "SOUTH MILWAUKEE",
    "PracticeLocationAddressStateName": "WI",
    "PracticeLocationAddressPostalCode": "53172",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "262-215-3279",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "12/27/2012",
    "LastUpdateDate": "03/20/2023",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": "02/06/2023",
    "NPIReactivationDate": "03/20/2023",
    "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": "5184-26",
        "LicenseNumberStateCode": "WI",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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