{
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"FirstLineMailingAddress": "1013 RIDGEFIELD DR",
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"MailingAddressCityName": "VALRICO",
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"MailingAddressCountryCode": "US",
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"FirstLinePracticeLocationAddress": "2020 W LAKE PARKER DR",
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"PracticeLocationAddressCityName": "LAKELAND",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "863-682-7580",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "02/25/2021",
"LastUpdateDate": "02/25/2021",
"NPIDeactivationReasonCode": null,
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"NPIReactivationDate": null,
"GenderCode": "F",
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"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Occupational Therapist",
"LicenseNumber": "OT21475",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}