{
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"FirstLineMailingAddress": "1888 15TH ST NW",
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"MailingAddressCityName": "WINTER HAVEN",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "33881-1302",
"MailingAddressCountryCode": "US",
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"FirstLinePracticeLocationAddress": "4725 US HIGHWAY 98 S STE 101-102",
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"PracticeLocationAddressCityName": "LAKELAND",
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"PracticeLocationAddressCountryCode": "US",
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"EnumerationDate": "03/29/2016",
"LastUpdateDate": "10/03/2023",
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
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"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Occupational Therapist",
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"LicenseNumberStateCode": "NC",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
}
}
}