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1801947510 NPI number — STACY ELAINE MATTOX OTR

NPI Number: 1801947510
Health Care Provider/Practitioner: STACY ELAINE MATTOX OTR

Information about “1801947510” NPI (STACY ELAINE MATTOX OTR) exists in 1801947510 in HTML format HTML  |  1801947510 in plain Text format TXT  |  1801947510 in PDF (Portable Document Format) PDF  |  1801947510 in an XML format XML  formats.

NPI Number : 1801947510 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1801947510",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "MATTOX",
    "FirstName": "STACY",
    "MiddleName": "ELAINE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "OTR",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "913 RIVER ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "BENTON",
    "MailingAddressStateName": "AR",
    "MailingAddressPostalCode": "72015-5024",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "501-240-9867",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1807 W MOLINE ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "MALVERN",
    "PracticeLocationAddressStateName": "AR",
    "PracticeLocationAddressPostalCode": "72104-2645",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "501-467-3166",
    "PracticeLocationAddressFaxNumber": "501-467-3161",
    "EnumerationDate": "01/16/2007",
    "LastUpdateDate": "05/13/2010",
    "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": "OTR1458",
        "LicenseNumberStateCode": "AR",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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