{
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"EIN": null,
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"OtherLastName": "POWERS",
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"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "11142 MAUSEL ST UNIT A",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "EAGLE RIVER",
"MailingAddressStateName": "AK",
"MailingAddressPostalCode": "99577-8097",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "214-298-4778",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "10421 VFW RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "EAGLE RIVER",
"PracticeLocationAddressStateName": "AK",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "907-694-1285",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "10/14/2022",
"LastUpdateDate": "10/14/2022",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
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"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "225700000X",
"TaxonomyName": "Massage Therapist",
"LicenseNumber": "194093",
"LicenseNumberStateCode": "AK",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}