{
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"EIN": null,
"IsSoleProprietor": "Y",
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"ParentOrgLBN": null,
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"OrgName": null,
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"Credential": "OTR/L",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "STEVENS",
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"OtherCredential": "OTR/L",
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "29 PINE ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SOUTH PARIS",
"MailingAddressStateName": "ME",
"MailingAddressPostalCode": "04281-1516",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "207-739-2021",
"MailingAddressFaxNumber": "207-739-2188",
"FirstLinePracticeLocationAddress": "29 PINE ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "SOUTH PARIS",
"PracticeLocationAddressStateName": "ME",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "207-739-2021",
"PracticeLocationAddressFaxNumber": "207-739-2188",
"EnumerationDate": "06/11/2009",
"LastUpdateDate": "09/16/2024",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
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"AuthorizedOfficialTitle": null,
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "225XP0200X",
"TaxonomyName": "Pediatric Occupational Therapist",
"LicenseNumber": "OT 418",
"LicenseNumberStateCode": "ME",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}