{
"Npi": {
"NPI": "1437464450",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "NITSCH",
"FirstName": "KELLI",
"MiddleName": "D",
"NamePrefix": "MRS.",
"NameSuffix": null,
"Credential": "MS, OTR/L",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "TALBERT",
"OtherFirstName": "KELLIE",
"OtherMiddleName": "D",
"OtherNamePrefix": "MRS.",
"OtherNameSuffix": null,
"OtherCredential": "MS, OTR/L",
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "4707 DEXTER AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "FORT WORTH",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "76107-3737",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "479-857-6637",
"MailingAddressFaxNumber": "479-967-1178",
"FirstLinePracticeLocationAddress": "306 E 11TH ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "RUSSELLVILLE",
"PracticeLocationAddressStateName": "AR",
"PracticeLocationAddressPostalCode": "72801-6156",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "479-968-1198",
"PracticeLocationAddressFaxNumber": "479-967-1178",
"EnumerationDate": "08/13/2010",
"LastUpdateDate": "07/13/2021",
"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": "225XP0200X",
"TaxonomyName": "Pediatric Occupational Therapist",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "225X00000X",
"TaxonomyName": "Occupational Therapist",
"LicenseNumber": "O-T1039",
"LicenseNumberStateCode": "AR",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}