{
"Npi": {
"NPI": "1457976391",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "MCLEAN",
"FirstName": "GRACE",
"MiddleName": "LYNN",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "COTA/L",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "CARLE",
"OtherFirstName": "GRACE",
"OtherMiddleName": "LYNN",
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "897 CHINA RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "WINSLOW",
"MailingAddressStateName": "ME",
"MailingAddressPostalCode": "04901-0318",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "207-751-7014",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "7 HIGHWOOD ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "WATERVILLE",
"PracticeLocationAddressStateName": "ME",
"PracticeLocationAddressPostalCode": "04901-5739",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "207-873-0705",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "06/16/2020",
"LastUpdateDate": "07/01/2021",
"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": "224Z00000X",
"TaxonomyName": "Occupational Therapy Assistant",
"LicenseNumber": "0831",
"LicenseNumberStateCode": "NH",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "224Z00000X",
"TaxonomyName": "Occupational Therapy Assistant",
"LicenseNumber": "OA3810",
"LicenseNumberStateCode": "ME",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}