{
"Npi": {
"NPI": "1578761417",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "BOGDANSKI",
"FirstName": "TRACY",
"MiddleName": "KODY",
"NamePrefix": "MRS.",
"NameSuffix": null,
"Credential": "OTR",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "33 GARDEN DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BERLIN",
"MailingAddressStateName": "CT",
"MailingAddressPostalCode": "06037-1230",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "860-829-8022",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1157 HIGHLAND AVE",
"SecondLinePracticeLocationAddress": "SUITE101",
"PracticeLocationAddressCityName": "CHESHIRE",
"PracticeLocationAddressStateName": "CT",
"PracticeLocationAddressPostalCode": "06410-1600",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "203-271-9288",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "07/03/2007",
"LastUpdateDate": "07/08/2007",
"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": "002744",
"LicenseNumberStateCode": "CT",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}