{
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"FirstLineMailingAddress": "86 MAINE ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BRUNSWICK",
"MailingAddressStateName": "ME",
"MailingAddressPostalCode": "04011-2015",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "207-725-5111",
"MailingAddressFaxNumber": "207-406-4411",
"FirstLinePracticeLocationAddress": "86 MAINE ST",
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"PracticeLocationAddressCityName": "BRUNSWICK",
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"PracticeLocationAddressFaxNumber": "207-406-4411",
"EnumerationDate": "12/31/2015",
"LastUpdateDate": "03/15/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "STRANGE",
"AuthorizedOfficialFirstName": "ANNA",
"AuthorizedOfficialMiddleName": "KELLY",
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"AuthorizedOfficialCredential": "AUD",
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"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Audiologist",
"LicenseNumber": "DL372",
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"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
}
}
}