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1720421340 NPI number — CAROLYN MARIE GUSTIN COTA/L

NPI Number: 1720421340
Health Care Provider/Practitioner: CAROLYN MARIE GUSTIN COTA/L

Information about “1720421340” NPI (CAROLYN MARIE GUSTIN COTA/L) exists in 1720421340 in HTML format HTML  |  1720421340 in plain Text format TXT  |  1720421340 in PDF (Portable Document Format) PDF  |  1720421340 in an XML format XML  formats.

NPI Number : 1720421340 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1720421340",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "GUSTIN",
    "FirstName": "CAROLYN",
    "MiddleName": "MARIE",
    "NamePrefix": "MS.",
    "NameSuffix": null,
    "Credential": "COTA/L",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "GUSTIN",
    "OtherFirstName": "CAROLYN",
    "OtherMiddleName": "MARIE",
    "OtherNamePrefix": "MS.",
    "OtherNameSuffix": null,
    "OtherCredential": "COTA/L",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "5801 ALLENTOWN ROAD",
    "SecondLineMailingAddress": "SUITE 410",
    "MailingAddressCityName": "CAMP SPRINGS",
    "MailingAddressStateName": "MD",
    "MailingAddressPostalCode": "20746",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "301-238-4788",
    "MailingAddressFaxNumber": "301-298-5442",
    "FirstLinePracticeLocationAddress": "5801 ALLENTOWN ROAD",
    "SecondLinePracticeLocationAddress": "SUITE 410",
    "PracticeLocationAddressCityName": "CAMP SPRINGS",
    "PracticeLocationAddressStateName": "MD",
    "PracticeLocationAddressPostalCode": "20746",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "301-238-4788",
    "PracticeLocationAddressFaxNumber": "301-298-5442",
    "EnumerationDate": "04/12/2013",
    "LastUpdateDate": "11/25/2022",
    "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": "224Z00000X",
          "TaxonomyName": "Occupational Therapy Assistant",
          "LicenseNumber": "100000251",
          "LicenseNumberStateCode": "DC",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "224Z00000X",
          "TaxonomyName": "Occupational Therapy Assistant",
          "LicenseNumber": "OTA 13076",
          "LicenseNumberStateCode": "FL",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "224Z00000X",
          "TaxonomyName": "Occupational Therapy Assistant",
          "LicenseNumber": "A02011",
          "LicenseNumberStateCode": "MD",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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