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1730504960 NPI number — MOLLY DETERS OTR/L

NPI Number: 1730504960
Health Care Provider/Practitioner: MOLLY DETERS OTR/L

Information about “1730504960” NPI (MOLLY DETERS OTR/L) exists in 1730504960 in HTML format HTML  |  1730504960 in plain Text format TXT  |  1730504960 in PDF (Portable Document Format) PDF  |  1730504960 in an XML format XML  formats.

NPI Number : 1730504960 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1730504960",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "DETERS",
    "FirstName": "MOLLY",
    "MiddleName": null,
    "NamePrefix": "MS.",
    "NameSuffix": null,
    "Credential": "OTR/L",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "419 BAY OAKS DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "PENSACOLA",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "32506-8155",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "859-750-2213",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "419 BAY OAKS DR",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "PENSACOLA",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "32506-8155",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "859-750-2213",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "02/25/2014",
    "LastUpdateDate": "10/21/2022",
    "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": "225X00000X",
          "TaxonomyName": "Occupational Therapist",
          "LicenseNumber": "R1306",
          "LicenseNumberStateCode": "KY",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "222Q00000X",
          "TaxonomyName": "Developmental Therapist",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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