{
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"FirstLineMailingAddress": "2505 ANTHEM VILLAGE DR STE E380",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "HENDERSON",
"MailingAddressStateName": "NV",
"MailingAddressPostalCode": "89052-5505",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "702-867-4266",
"MailingAddressFaxNumber": "702-867-4261",
"FirstLinePracticeLocationAddress": "10907 S EASTERN AVE STE 100",
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"PracticeLocationAddressCityName": "HENDERSON",
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"EnumerationDate": "10/24/2019",
"LastUpdateDate": "10/24/2019",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BUTZMAN",
"AuthorizedOfficialFirstName": "BRYNN",
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"AuthorizedOfficialTitle": "OWNER/OCCUPATIONAL THERAPIST",
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"AuthorizedOfficialCredential": "OTD, OTR/L",
"AuthorizedOfficialTelephoneNumber": "408-813-1762",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "225XP0200X",
"TaxonomyName": "Pediatric Occupational Therapist",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}