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1720291115 NPI number — GAMINEE PATEL SURA OTR/L

NPI Number: 1720291115
Health Care Provider/Practitioner: GAMINEE PATEL SURA OTR/L

Information about “1720291115” NPI (GAMINEE PATEL SURA OTR/L) exists in 1720291115 in HTML format HTML  |  1720291115 in plain Text format TXT  |  1720291115 in PDF (Portable Document Format) PDF  |  1720291115 in an XML format XML  formats.

NPI Number : 1720291115 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1720291115",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "SURA",
    "FirstName": "GAMINEE",
    "MiddleName": "PATEL",
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": "OTR/L",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "PATEL",
    "OtherFirstName": "GAMINEE",
    "OtherMiddleName": "BHARAT",
    "OtherNamePrefix": "MISS",
    "OtherNameSuffix": null,
    "OtherCredential": "OTR/L",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "2740 W ARMITAGE AVE",
    "SecondLineMailingAddress": "UNIT 403S",
    "MailingAddressCityName": "CHICAGO",
    "MailingAddressStateName": "IL",
    "MailingAddressPostalCode": "60647-4240",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "773-412-9849",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "2740 W ARMITAGE AVE",
    "SecondLinePracticeLocationAddress": "UNIT 403S",
    "PracticeLocationAddressCityName": "CHICAGO",
    "PracticeLocationAddressStateName": "IL",
    "PracticeLocationAddressPostalCode": "60647-4240",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "773-412-9849",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "05/08/2007",
    "LastUpdateDate": "11/20/2009",
    "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": "056.006520",
        "LicenseNumberStateCode": "IL",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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