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1205393303 NPI number — KATHLEEN ELIZABETH REARDON OT

NPI Number: 1205393303
Health Care Provider/Practitioner: KATHLEEN ELIZABETH REARDON OT

Information about “1205393303” NPI (KATHLEEN ELIZABETH REARDON OT) exists in 1205393303 in HTML format HTML  |  1205393303 in plain Text format TXT  |  1205393303 in PDF (Portable Document Format) PDF  |  1205393303 in an XML format XML  formats.

NPI Number : 1205393303 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1205393303",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "REARDON",
    "FirstName": "KATHLEEN",
    "MiddleName": "ELIZABETH",
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": "OT",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "KULKA",
    "OtherFirstName": "KATHLEEN",
    "OtherMiddleName": "ELIZABETH",
    "OtherNamePrefix": "MISS",
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "494 W CENTRAL AVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "DELAWARE",
    "MailingAddressStateName": "OH",
    "MailingAddressPostalCode": "43015-1470",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "494 W CENTRAL AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "DELAWARE",
    "PracticeLocationAddressStateName": "OH",
    "PracticeLocationAddressPostalCode": "43015-1470",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "403-693-6507",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "02/25/2019",
    "LastUpdateDate": "08/13/2020",
    "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": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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