1265825400 NPI number — JESSICA T MAXWELL PHD, OTD, OTR, CEAS

NPI Number: 1265825400
Health Care Provider/Practitioner: JESSICA T MAXWELL PHD, OTD, OTR, CEAS

NPI Number : 1265825400 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1265825400",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "MAXWELL",
    "FirstName": "JESSICA",
    "MiddleName": "T",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "PHD, OTD, OTR, CEAS",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "348 GOODFELLA AVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "CIBOLO",
    "MailingAddressStateName": "TX",
    "MailingAddressPostalCode": "78108-0198",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "205-907-7768",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "348 GOODFELLA AVE STE 240",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "CIBOLO",
    "PracticeLocationAddressStateName": "TX",
    "PracticeLocationAddressPostalCode": "78108-0198",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "205-907-7768",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "03/12/2015",
    "LastUpdateDate": "10/15/2024",
    "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": "225XE1200X",
          "TaxonomyName": "Ergonomics Occupational Therapist",
          "LicenseNumber": "122789",
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "225X00000X",
          "TaxonomyName": "Occupational Therapist",
          "LicenseNumber": "122789",
          "LicenseNumberStateCode": "TX",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}