1245715549 NPI number — MINDY MARIE BROWN C.O.T.A.

NPI Number: 1245715549
Health Care Provider/Practitioner: MINDY MARIE BROWN C.O.T.A.

NPI Number : 1245715549 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1245715549",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BROWN",
    "FirstName": "MINDY",
    "MiddleName": "MARIE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "C.O.T.A.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "1276 E 1250 S",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "CLEARFIELD",
    "MailingAddressStateName": "UT",
    "MailingAddressPostalCode": "84015-1342",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "810-721-8183",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1276 E 1250 S",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "CLEARFIELD",
    "PracticeLocationAddressStateName": "UT",
    "PracticeLocationAddressPostalCode": "84015-1342",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "810-721-8183",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "10/02/2018",
    "LastUpdateDate": "10/02/2018",
    "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": "224Z00000X",
          "TaxonomyName": "Occupational Therapy Assistant",
          "LicenseNumber": "009894-1",
          "LicenseNumberStateCode": "NY",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "224Z00000X",
          "TaxonomyName": "Occupational Therapy Assistant",
          "LicenseNumber": "9357141-4202",
          "LicenseNumberStateCode": "UT",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}