{
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"FirstLineMailingAddress": "1402 LAKE TAPPS PKWY E STE 104",
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"MailingAddressStateName": "WA",
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"FirstLinePracticeLocationAddress": "18223 9TH ST E STE B",
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"PracticeLocationAddressCityName": "LAKE TAPPS",
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"EnumerationDate": "10/04/2015",
"LastUpdateDate": "10/04/2015",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
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"AuthorizedOfficialLastName": "EMRY",
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"AuthorizedOfficialTelephoneNumber": "253-740-6613",
"Taxonomies": {
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"LicenseNumber": "MA 60503660",
"LicenseNumberStateCode": "WA",
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}
},
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}
}
}
}