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1467880971 NPI number — AMANDA ELIZABETH SMITH MS, OTRL

NPI Number: 1467880971
Health Care Provider/Practitioner: AMANDA ELIZABETH SMITH MS, OTRL

Information about “1467880971” NPI (AMANDA ELIZABETH SMITH MS, OTRL) exists in 1467880971 in HTML format HTML  |  1467880971 in plain Text format TXT  |  1467880971 in PDF (Portable Document Format) PDF  |  1467880971 in an XML format XML  formats.

NPI Number : 1467880971 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1467880971",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "SMITH",
    "FirstName": "AMANDA",
    "MiddleName": "ELIZABETH",
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": "MS, OTRL",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "THEISEN",
    "OtherFirstName": "AMANDA",
    "OtherMiddleName": "ELIZABETH",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "MS, OTRL",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "18501 ROTUNDA DR STE 100",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "DEARBORN",
    "MailingAddressStateName": "MI",
    "MailingAddressPostalCode": "48124-3891",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "313-996-1930",
    "MailingAddressFaxNumber": "313-996-1935",
    "FirstLinePracticeLocationAddress": "18501 ROTUNDA DR STE 100",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "DEARBORN",
    "PracticeLocationAddressStateName": "MI",
    "PracticeLocationAddressPostalCode": "48124-3891",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "313-996-1949",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "10/18/2013",
    "LastUpdateDate": "09/12/2018",
    "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": "5201008628",
          "LicenseNumberStateCode": "MI",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "225XP0200X",
          "TaxonomyName": "Pediatric Occupational Therapist",
          "LicenseNumber": "5201008628",
          "LicenseNumberStateCode": "MI",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
      }
    }
  }
}
                
            

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