{
"Npi": {
"NPI": "1679973010",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "WISE",
"FirstName": "PAMELA",
"MiddleName": "LAWSON",
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "MOORE",
"OtherFirstName": "PAMELA",
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "1460 HOLIDAY BLVD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MERRITT ISLAND",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "32952-5537",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "704-941-4592",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1460 HOLIDAY BLVD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "MERRITT ISLAND",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "32952-5537",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "49-414-5927",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "09/03/2014",
"LastUpdateDate": "04/22/2022",
"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": "222Q00000X",
"TaxonomyName": "Developmental Therapist",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}