{
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"FirstLineMailingAddress": "121 CASEY ST STE A",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CAMPBELLSVILLE",
"MailingAddressStateName": "KY",
"MailingAddressPostalCode": "42718-6858",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "270-465-7768",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "121 CASEY ST STE A",
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"PracticeLocationAddressCityName": "CAMPBELLSVILLE",
"PracticeLocationAddressStateName": "KY",
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"PracticeLocationAddressTelephoneNumber": "270-465-7768",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "02/12/2015",
"LastUpdateDate": "02/12/2015",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "CLOSE",
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"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "CO-OWNER AND OT",
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"AuthorizedOfficialCredential": "MS, OTR/L",
"AuthorizedOfficialTelephoneNumber": "270-465-7768",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Specialist",
"LicenseNumber": "005957",
"LicenseNumberStateCode": "KY",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
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}
}
}
}