{
"Npi": {
"NPI": "1275085961",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "LIFE LONG OCCUPATIONAL THERAPY SERVICES, INC",
"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": "1741 HIGHWAY 399",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BEATTYVILLE",
"MailingAddressStateName": "KY",
"MailingAddressPostalCode": "41311-7974",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "606-424-8011",
"MailingAddressFaxNumber": "606-464-9633",
"FirstLinePracticeLocationAddress": "1741 HIGHWAY 399",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "BEATTYVILLE",
"PracticeLocationAddressStateName": "KY",
"PracticeLocationAddressPostalCode": "41311-7974",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "606-424-8011",
"PracticeLocationAddressFaxNumber": "606-464-9633",
"EnumerationDate": "10/27/2016",
"LastUpdateDate": "10/27/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MCINTOSH",
"AuthorizedOfficialFirstName": "DEBRA",
"AuthorizedOfficialMiddleName": "RUTH",
"AuthorizedOfficialTitle": "PRESIDENT/OWNER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "OTR/L",
"AuthorizedOfficialTelephoneNumber": "606-424-8011",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "252Y00000X",
"TaxonomyName": "Early Intervention Provider Agency",
"LicenseNumber": "134454",
"LicenseNumberStateCode": "KY",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}