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1144619255 NPI number — LEILANI BASILIO FONACIER MAOT, OTR/L

NPI Number: 1144619255
Health Care Provider/Practitioner: LEILANI BASILIO FONACIER MAOT, OTR/L

Information about “1144619255” NPI (LEILANI BASILIO FONACIER MAOT, OTR/L) exists in 1144619255 in HTML format HTML  |  1144619255 in plain Text format TXT  |  1144619255 in PDF (Portable Document Format) PDF  |  1144619255 in an XML format XML  formats.

NPI Number : 1144619255 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1144619255",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "FONACIER",
    "FirstName": "LEILANI",
    "MiddleName": "BASILIO",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "MAOT, OTR/L",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "5710 S GLENNIE LN",
    "SecondLineMailingAddress": "APT F",
    "MailingAddressCityName": "LOS ANGELES",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "90016-1062",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "5710 S GLENNIE LN",
    "SecondLinePracticeLocationAddress": "APT F",
    "PracticeLocationAddressCityName": "LOS ANGELES",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "90016-1062",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "323-992-7100",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "01/13/2015",
    "LastUpdateDate": "01/13/2015",
    "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": "12394",
        "LicenseNumberStateCode": "CA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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