{
"Npi": {
"NPI": "1043733769",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "CATHCART",
"FirstName": "KELSEY",
"MiddleName": "RENAE",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "OTR/L",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "NICKLAS",
"OtherFirstName": "KELSEY",
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "11621 N 126TH EAST AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "COLLINSVILLE",
"MailingAddressStateName": "OK",
"MailingAddressPostalCode": "74021-5435",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "918-630-4363",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "3223 E 31ST ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "TULSA",
"PracticeLocationAddressStateName": "OK",
"PracticeLocationAddressPostalCode": "74105-2452",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "918-250-7093",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "07/25/2017",
"LastUpdateDate": "02/12/2025",
"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": "225X00000X",
"TaxonomyName": "Occupational Therapist",
"LicenseNumber": "6063",
"LicenseNumberStateCode": "OK",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}