{
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"FirstLineMailingAddress": "3136 DOUBLE CAMP RD",
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"MailingAddressCityName": "SALEM",
"MailingAddressStateName": "WV",
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"MailingAddressCountryCode": "US",
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"MailingAddressFaxNumber": "304-782-2437",
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"PracticeLocationAddressTelephoneNumber": "304-991-3120",
"PracticeLocationAddressFaxNumber": "304-782-2437",
"EnumerationDate": "11/13/2024",
"LastUpdateDate": "11/13/2024",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
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"NPIReactivationDate": null,
"GenderCode": "F",
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"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Early Intervention Provider Agency",
"LicenseNumber": "478332",
"LicenseNumberStateCode": "WV",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}