NPI Code Detail JSON Logo

1659769628 NPI number — JO LEE ERICKSON OTR/L

NPI Number: 1659769628
Health Care Provider/Practitioner: JO LEE ERICKSON OTR/L

Information about “1659769628” NPI (JO LEE ERICKSON OTR/L) exists in 1659769628 in HTML format HTML  |  1659769628 in plain Text format TXT  |  1659769628 in PDF (Portable Document Format) PDF  |  1659769628 in an XML format XML  formats.

NPI Number : 1659769628 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1659769628",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "ERICKSON",
    "FirstName": "JO",
    "MiddleName": "LEE",
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": "OTR/L",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "WILSON",
    "OtherFirstName": "JO",
    "OtherMiddleName": "LEE",
    "OtherNamePrefix": "MISS",
    "OtherNameSuffix": null,
    "OtherCredential": "OTR/L",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "911 PORT ARTHUR AVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "MENA",
    "MailingAddressStateName": "AR",
    "MailingAddressPostalCode": "71953-3138",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "870-584-8064",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1127 HIGHWAY 71 S",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "MENA",
    "PracticeLocationAddressStateName": "AR",
    "PracticeLocationAddressPostalCode": "71953-4033",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "870-584-8064",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "12/29/2014",
    "LastUpdateDate": "07/26/2023",
    "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": "OTR2783",
          "LicenseNumberStateCode": "AR",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "225X00000X",
          "TaxonomyName": "Occupational Therapist",
          "LicenseNumber": "2783",
          "LicenseNumberStateCode": "AR",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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