{
"Npi": {
"NPI": "1295057776",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "BOLANOS-ESCALONA",
"FirstName": "ANGIE",
"MiddleName": "LISSETTE",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "OTR",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "15751 SHERIDAN ST",
"SecondLineMailingAddress": "STE 162",
"MailingAddressCityName": "FORT LAUDERDALE",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "33331-3486",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "786-348-6361",
"MailingAddressFaxNumber": "866-665-8671",
"FirstLinePracticeLocationAddress": "1401 E 4TH AVE",
"SecondLinePracticeLocationAddress": "STE 204",
"PracticeLocationAddressCityName": "HIALEAH",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "33010-3504",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "786-348-6361",
"PracticeLocationAddressFaxNumber": "866-665-8671",
"EnumerationDate": "02/24/2010",
"LastUpdateDate": "04/23/2017",
"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": "225X00000X",
"TaxonomyName": "Occupational Therapist",
"LicenseNumber": "9463",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}