{
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"FirstLineMailingAddress": "1206 HULL RD SPC 2",
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"MailingAddressFaxNumber": "419-324-1110",
"FirstLinePracticeLocationAddress": "1206 HULL RD SPC 2",
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"PracticeLocationAddressTelephoneNumber": "419-502-3516",
"PracticeLocationAddressFaxNumber": "419-324-1110",
"EnumerationDate": "09/18/2024",
"LastUpdateDate": "11/06/2024",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
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"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "231H00000X",
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"LicenseNumber": "292808",
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"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "231H00000X",
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}
]
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}