{
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"NPI": "1174993901",
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"ReplacementNPI": null,
"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "RIVER CITY REHAB & VOCATIONAL SERVICES, LLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
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"OtherOrgNameTypeCode": null,
"OtherLastName": null,
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"OtherNamePrefix": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "PO BOX 251",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "WHEELERSBURG",
"MailingAddressStateName": "OH",
"MailingAddressPostalCode": "45694-0251",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "740-935-0685",
"MailingAddressFaxNumber": "740-981-3173",
"FirstLinePracticeLocationAddress": "430 DEWEY ST",
"SecondLinePracticeLocationAddress": "#4",
"PracticeLocationAddressCityName": "WHEELERSBURG",
"PracticeLocationAddressStateName": "OH",
"PracticeLocationAddressPostalCode": "45694-1757",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "740-935-0685",
"PracticeLocationAddressFaxNumber": "740-981-3173",
"EnumerationDate": "10/06/2015",
"LastUpdateDate": "10/06/2015",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "NEWSOM",
"AuthorizedOfficialFirstName": "CINDY",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER - OCCUPATIONAL THERAPIST",
"AuthorizedOfficialNamePrefix": "MS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "OT",
"AuthorizedOfficialTelephoneNumber": "740-935-0685",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "225XP0200X",
"TaxonomyName": "Pediatric Occupational Therapist",
"LicenseNumber": "R0952",
"LicenseNumberStateCode": "KY",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}