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1366984882 NPI number — QUINTON DJ EVANS MSOT OTR/L

NPI Number: 1366984882
Health Care Provider/Practitioner: QUINTON DJ EVANS MSOT OTR/L

Information about “1366984882” NPI (QUINTON DJ EVANS MSOT OTR/L) exists in 1366984882 in HTML format HTML  |  1366984882 in plain Text format TXT  |  1366984882 in PDF (Portable Document Format) PDF  |  1366984882 in an XML format XML  formats.

NPI Number : 1366984882 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1366984882",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "EVANS",
    "FirstName": "QUINTON",
    "MiddleName": "DJ",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "MSOT OTR/L",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "9110 CRANBROOK DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "NORTHFIELD",
    "MailingAddressStateName": "OH",
    "MailingAddressPostalCode": "44067-1321",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "330-348-7238",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "9110 CRANBROOK DR",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "NORTHFIELD",
    "PracticeLocationAddressStateName": "OH",
    "PracticeLocationAddressPostalCode": "44067-1321",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "330-348-7238",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "11/15/2016",
    "LastUpdateDate": "10/29/2021",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": "10/19/2021",
    "NPIReactivationDate": "10/28/2021",
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "390200000X",
          "TaxonomyName": "Student in an Organized Health Care Education/Training Program",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "2255A2300X",
          "TaxonomyName": "Athletic Trainer",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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