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1417621319 NPI number — TAYLOR NICOLE LUSK OTR/L

NPI Number: 1417621319
Health Care Provider/Practitioner: TAYLOR NICOLE LUSK OTR/L

Information about “1417621319” NPI (TAYLOR NICOLE LUSK OTR/L) exists in 1417621319 in HTML format HTML  |  1417621319 in plain Text format TXT  |  1417621319 in PDF (Portable Document Format) PDF  |  1417621319 in an XML format XML  formats.

NPI Number : 1417621319 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1417621319",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "LUSK",
    "FirstName": "TAYLOR",
    "MiddleName": "NICOLE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "OTR/L",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "JACKSON",
    "OtherFirstName": "TAYLOR",
    "OtherMiddleName": "NICOLE",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "254 PARSONAGE DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "DANIELS",
    "MailingAddressStateName": "WV",
    "MailingAddressPostalCode": "25832-9687",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "304-575-1594",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1436 CENTRAL AVE E",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "WIGGINS",
    "PracticeLocationAddressStateName": "MS",
    "PracticeLocationAddressPostalCode": "39577-9602",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "601-928-1889",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "08/04/2021",
    "LastUpdateDate": "08/04/2021",
    "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": "OT-3859",
          "LicenseNumberStateCode": "MS",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "225X00000X",
          "TaxonomyName": "Occupational Therapist",
          "LicenseNumber": "2129",
          "LicenseNumberStateCode": "WV",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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