{
"Npi": {
"NPI": "1295337590",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "MATILE",
"FirstName": "STEPHANIE",
"MiddleName": "ELIZABETH",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "OTR/L",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "COLLINS",
"OtherFirstName": "STEPHANIE",
"OtherMiddleName": "ELIZABETH",
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": "OTR/L",
"OtherLastNameTypeCode": "5",
"FirstLineMailingAddress": "2902 FACEL VEGA DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "JOLIET",
"MailingAddressStateName": "IL",
"MailingAddressPostalCode": "60435-6487",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "815-557-7787",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "807 W JEFFERSON ST UNIT U",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "SHOREWOOD",
"PracticeLocationAddressStateName": "IL",
"PracticeLocationAddressPostalCode": "60404-7301",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "815-714-2977",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "11/11/2020",
"LastUpdateDate": "02/20/2023",
"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": "225XP0200X",
"TaxonomyName": "Pediatric Occupational Therapist",
"LicenseNumber": "056.013444",
"LicenseNumberStateCode": "IL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}