{
"Npi": {
"NPI": "1295977551",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "MARTEL",
"FirstName": "MICHAEL",
"MiddleName": "ROY",
"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": "1300 COTTAGE GROVE AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "KIRKSVILLE",
"MailingAddressStateName": "MO",
"MailingAddressPostalCode": "63501-3910",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "660-216-7082",
"MailingAddressFaxNumber": "660-626-1439",
"FirstLinePracticeLocationAddress": "1300 COTTAGE GROVE AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "KIRKSVILLE",
"PracticeLocationAddressStateName": "MO",
"PracticeLocationAddressPostalCode": "63501-3910",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "660-216-7082",
"PracticeLocationAddressFaxNumber": "660-626-1439",
"EnumerationDate": "04/01/2009",
"LastUpdateDate": "12/17/2021",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
"Gender": "Male",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "235Z00000X",
"TaxonomyName": "Speech-Language Pathologist",
"LicenseNumber": "2012012817",
"LicenseNumberStateCode": "MO",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}