{
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"FirstLineMailingAddress": "6321 JAMES ROUSE BLVD",
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"MailingAddressStateName": "OH",
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"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": null,
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "5160 EAST MAIN ST",
"SecondLinePracticeLocationAddress": "LOFT 26",
"PracticeLocationAddressCityName": "WHITEHALL",
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"EnumerationDate": "05/19/2021",
"LastUpdateDate": "05/31/2021",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "REID",
"AuthorizedOfficialFirstName": "VANIETY",
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"AuthorizedOfficialTelephoneNumber": "614-636-0067",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "335E00000X",
"TaxonomyName": "Prosthetic/Orthotic Supplier",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}