{
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"FirstLineMailingAddress": "1221 S BALSAM ST APT 22",
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"MailingAddressCityName": "MOSES LAKE",
"MailingAddressStateName": "WA",
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"FirstLinePracticeLocationAddress": "1639 FAIRWAY DR NE",
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"PracticeLocationAddressCityName": "MOSES LAKE",
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"PracticeLocationAddressTelephoneNumber": "509-760-3068",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "02/23/2017",
"LastUpdateDate": "04/17/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
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"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Massage Therapist",
"LicenseNumber": "MA61035351",
"LicenseNumberStateCode": "WA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}