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1255549630 NPI number — DENNIS LIM BAUTISTA OTR

NPI Number: 1255549630
Health Care Provider/Practitioner: DENNIS LIM BAUTISTA OTR

Information about “1255549630” NPI (DENNIS LIM BAUTISTA OTR) exists in 1255549630 in HTML format HTML  |  1255549630 in plain Text format TXT  |  1255549630 in PDF (Portable Document Format) PDF  |  1255549630 in an XML format XML  formats.

NPI Number : 1255549630 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1255549630",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BAUTISTA",
    "FirstName": "DENNIS",
    "MiddleName": "LIM",
    "NamePrefix": "MR.",
    "NameSuffix": null,
    "Credential": "OTR",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "BAUTISTA",
    "OtherFirstName": "DENNIS",
    "OtherMiddleName": "LIM",
    "OtherNamePrefix": "MR.",
    "OtherNameSuffix": null,
    "OtherCredential": "OTR",
    "OtherLastNameTypeCode": "2",
    "FirstLineMailingAddress": "5342 W PATTERSON AVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "CHICAGO",
    "MailingAddressStateName": "IL",
    "MailingAddressPostalCode": "60641-3346",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "219-448-2482",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "820 S DAMEN AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "CHICAGO",
    "PracticeLocationAddressStateName": "IL",
    "PracticeLocationAddressPostalCode": "60612-3728",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "312-569-8387",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "05/18/2007",
    "LastUpdateDate": "09/07/2023",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "225X00000X",
        "TaxonomyName": "Occupational Therapist",
        "LicenseNumber": "056008257",
        "LicenseNumberStateCode": "IL",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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