{
"Npi": {
"NPI": "1285985002",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "KORNILKIN",
"FirstName": "JULIE",
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": "LICENSED MASSAGE THE",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "9021 S. GIBSON RD.",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MOLALLA",
"MailingAddressStateName": "OR",
"MailingAddressPostalCode": "97038",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "503-951-7082",
"MailingAddressFaxNumber": "503-263-1185",
"FirstLinePracticeLocationAddress": "9021 S. GIBSON RD.",
"SecondLinePracticeLocationAddress": "BLDG. B",
"PracticeLocationAddressCityName": "MOLALLA",
"PracticeLocationAddressStateName": "OR",
"PracticeLocationAddressPostalCode": "97038",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "503-951-7082",
"PracticeLocationAddressFaxNumber": "503-263-1185",
"EnumerationDate": "09/20/2012",
"LastUpdateDate": "09/20/2012",
"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": "225700000X",
"TaxonomyName": "Massage Therapist",
"LicenseNumber": "11296",
"LicenseNumberStateCode": "OR",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}