{
"Npi": {
"NPI": "1063566248",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "FOX",
"FirstName": "JACQUELINE",
"MiddleName": "LISA",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "OTR",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "FOX-LONG",
"OtherFirstName": "JACQUELINE",
"OtherMiddleName": "LISA",
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": "OTR",
"OtherLastNameTypeCode": "5",
"FirstLineMailingAddress": "24724 N 119TH PL",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SCOTTSDALE",
"MailingAddressStateName": "AZ",
"MailingAddressPostalCode": "85255-5928",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "480-907-6292",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "8115 E INDIAN BEND RD STE 123",
"SecondLinePracticeLocationAddress": "THERAPY REHABILITATION SERVICES",
"PracticeLocationAddressCityName": "SCOTTSDALE",
"PracticeLocationAddressStateName": "AZ",
"PracticeLocationAddressPostalCode": "85250-4819",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "480-951-6451",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "01/23/2007",
"LastUpdateDate": "07/08/2007",
"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": "916948",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "225X00000X",
"TaxonomyName": "Occupational Therapist",
"LicenseNumber": "3442",
"LicenseNumberStateCode": "AZ",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}