NPI Code Detail JSON Logo

1225977812 NPI number — RESILIENT ROOTS OT LLC

NPI Number: 1225977812
Health Care Provider/Practitioner: RESILIENT ROOTS OT LLC

Information about “1225977812” NPI (RESILIENT ROOTS OT LLC) exists in 1225977812 in HTML format HTML  |  1225977812 in plain Text format TXT  |  1225977812 in PDF (Portable Document Format) PDF  |  1225977812 in an XML format XML  formats.

NPI Number : 1225977812 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1225977812",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "RESILIENT ROOTS OT LLC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "550 COOKMAN AVE APT 225",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "ASBURY PARK",
    "MailingAddressStateName": "NJ",
    "MailingAddressPostalCode": "07712-7182",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "732-236-3485",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "12 REMINGTON DR",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "EDISON",
    "PracticeLocationAddressStateName": "NJ",
    "PracticeLocationAddressPostalCode": "08820-3635",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "732-236-3485",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "03/27/2026",
    "LastUpdateDate": "03/27/2026",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "DICK",
    "AuthorizedOfficialFirstName": "MCKENNA",
    "AuthorizedOfficialMiddleName": "MARY",
    "AuthorizedOfficialTitle": "MEMBER/PART OWNER",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "OTR/L",
    "AuthorizedOfficialTelephoneNumber": "732-236-3485",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "225XP0200X",
        "TaxonomyName": "Pediatric Occupational Therapist",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "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."
      }
    }
  }
}
                
            

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