1780840645 NPI number — ANGELLA DAWN POPINGA OTR/L, CLT-LANA

NPI Number: 1780840645
Health Care Provider/Practitioner: ANGELLA DAWN POPINGA OTR/L, CLT-LANA

NPI Number : 1780840645 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1780840645",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "POPINGA",
    "FirstName": "ANGELLA",
    "MiddleName": "DAWN",
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": "OTR/L, CLT-LANA",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "7 W VALLEY CT",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "NEWNAN",
    "MailingAddressStateName": "GA",
    "MailingAddressPostalCode": "30263-7452",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "600 CELEBRATE LIFE PKWY",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "NEWNAN",
    "PracticeLocationAddressStateName": "GA",
    "PracticeLocationAddressPostalCode": "30265-8001",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "770-400-6430",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "07/31/2008",
    "LastUpdateDate": "03/17/2018",
    "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": "456",
          "LicenseNumberStateCode": "ND",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "225X00000X",
          "TaxonomyName": "Occupational Therapist",
          "LicenseNumber": "OT005682",
          "LicenseNumberStateCode": "GA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}