{
"Npi": {
"NPI": "1124440383",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "MARTINELLI",
"FirstName": "STACEY",
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "17700 W CAPITOL DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BROOKFIELD",
"MailingAddressStateName": "WI",
"MailingAddressPostalCode": "53045-2006",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "262-781-3083",
"MailingAddressFaxNumber": "262-781-3080",
"FirstLinePracticeLocationAddress": "4772 KATELLA AVE",
"SecondLinePracticeLocationAddress": "SUITE 100",
"PracticeLocationAddressCityName": "LOS ALAMITOS",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "90720-2600",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "562-430-8700",
"PracticeLocationAddressFaxNumber": "562-430-8760",
"EnumerationDate": "01/07/2014",
"LastUpdateDate": "09/18/2019",
"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": "6611",
"LicenseNumberStateCode": "WI",
"PrimaryTaxonomySwitch": "Y"
},
{
"TaxonomyCode": "225X00000X",
"TaxonomyName": "Occupational Therapist",
"LicenseNumber": "1782",
"LicenseNumberStateCode": "NE",
"PrimaryTaxonomySwitch": "N"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}