{
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"IsOrgSubpart": "N",
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"OrgName": "MARENGO OCCUPATIONAL THERAPY SERVICES, INC",
"LastName": null,
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"NamePrefix": null,
"NameSuffix": null,
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"FirstLineMailingAddress": "PO BOX 683",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BELVIDERE",
"MailingAddressStateName": "IL",
"MailingAddressPostalCode": "61008-0683",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "815-568-8878",
"MailingAddressFaxNumber": "815-568-9977",
"FirstLinePracticeLocationAddress": "212 LINDOW LN",
"SecondLinePracticeLocationAddress": "SUITE M",
"PracticeLocationAddressCityName": "MARENGO",
"PracticeLocationAddressStateName": "IL",
"PracticeLocationAddressPostalCode": "60152-9480",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "815-568-8878",
"PracticeLocationAddressFaxNumber": "815-568-9977",
"EnumerationDate": "02/22/2013",
"LastUpdateDate": "02/22/2013",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "LINK",
"AuthorizedOfficialFirstName": "JONATHAN",
"AuthorizedOfficialMiddleName": "S",
"AuthorizedOfficialTitle": "PRESIDENT / PHYSICAL THERAPIST",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MPT",
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"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "225100000X",
"TaxonomyName": "Physical Therapist",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}