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1134263551 NPI number — SARAH TISTSI MBIZA PHD, OTR/L, CRC

NPI Number: 1134263551
Health Care Provider/Practitioner: SARAH TISTSI MBIZA PHD, OTR/L, CRC

Information about “1134263551” NPI (SARAH TISTSI MBIZA PHD, OTR/L, CRC) exists in 1134263551 in HTML format HTML  |  1134263551 in plain Text format TXT  |  1134263551 in PDF (Portable Document Format) PDF  |  1134263551 in an XML format XML  formats.

NPI Number : 1134263551 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1134263551",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "MBIZA",
    "FirstName": "SARAH",
    "MiddleName": "TISTSI",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "PHD, OTR/L, CRC",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "MASIYANDIMA",
    "OtherFirstName": "SARAH",
    "OtherMiddleName": "TSITSI",
    "OtherNamePrefix": "MRS.",
    "OtherNameSuffix": null,
    "OtherCredential": "OTR",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "8958 W STATE ROAD 84 # 261",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "DAVIE",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "33324-4457",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "954-271-2730",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "12941 NW 2ND ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "PEMBROKE PINES",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "33028-2295",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "954-271-2730",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "02/18/2007",
    "LastUpdateDate": "11/13/2020",
    "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": "OT-8092",
          "LicenseNumberStateCode": "FL",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "103TC0700X",
          "TaxonomyName": "Clinical Psychologist",
          "LicenseNumber": "PY10089",
          "LicenseNumberStateCode": "FL",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "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."
      }
    }
  }
}
                
            

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