{
"Npi": {
"NPI": "1649647900",
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"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "MARILYN BOSWORTH, SLP",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
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"OtherLastName": null,
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"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "105 ALSACE CT",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "PONTE VEDRA BEACH",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "32082-2950",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "904-343-4727",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "105 ALSACE CT",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "PONTE VEDRA BEACH",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "32082-2950",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "904-343-4727",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "08/21/2015",
"LastUpdateDate": "08/21/2015",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BOSWORTH",
"AuthorizedOfficialFirstName": "JONATHAN",
"AuthorizedOfficialMiddleName": "WALTON",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "HUSBAND",
"AuthorizedOfficialTelephoneNumber": "904-273-8266",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "252Y00000X",
"TaxonomyName": "Early Intervention Provider Agency",
"LicenseNumber": "SA6123",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}