{
"Npi": {
"NPI": "1205382850",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "HIGHLANDS OCCUPATIONAL THERAPY, INC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "123 HWY 27 NORTH",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SEBRING",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "33870",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "863-471-6303",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "250 3RD STREET NW",
"SecondLinePracticeLocationAddress": "SUITE 202",
"PracticeLocationAddressCityName": "WINTER HAVEN",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "33881",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "863-662-3935",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "09/01/2016",
"LastUpdateDate": "08/05/2019",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "CASTELLI",
"AuthorizedOfficialFirstName": "JENNIFER",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "OTR/L, CHT",
"AuthorizedOfficialTelephoneNumber": "863-471-6303",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "225X00000X",
"TaxonomyName": "Occupational Therapist",
"LicenseNumber": "OT 17460",
"LicenseNumberStateCode": "FL",
"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."
}
}
}
}