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1306177506 NPI number — SUSAN L NICHOLS OTR/L

NPI Number: 1306177506
Health Care Provider/Practitioner: SUSAN L NICHOLS OTR/L

Information about “1306177506” NPI (SUSAN L NICHOLS OTR/L) exists in 1306177506 in HTML format HTML  |  1306177506 in plain Text format TXT  |  1306177506 in PDF (Portable Document Format) PDF  |  1306177506 in an XML format XML  formats.

NPI Number : 1306177506 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1306177506",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "NICHOLS",
    "FirstName": "SUSAN",
    "MiddleName": "L",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "OTR/L",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "WILLINGHAM",
    "OtherFirstName": "SUSAN",
    "OtherMiddleName": "L",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "OTR/L",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "PO BOX 1433",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "FRIDAY HARBOR",
    "MailingAddressStateName": "WA",
    "MailingAddressPostalCode": "98250-1433",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "360-317-6480",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "880 GUARD ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "FRIDAY HARBOR",
    "PracticeLocationAddressStateName": "WA",
    "PracticeLocationAddressPostalCode": "98250",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "360-317-6480",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "01/27/2010",
    "LastUpdateDate": "09/04/2014",
    "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": "OT00001892",
          "LicenseNumberStateCode": "WA",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "225XP0200X",
          "TaxonomyName": "Pediatric Occupational Therapist",
          "LicenseNumber": "OT00001892",
          "LicenseNumberStateCode": "WA",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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