{
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"OtherCredential": null,
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"FirstLineMailingAddress": "2301 JOHN F KENNEDY BLVD APT 605",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "PHILADELPHIA",
"MailingAddressStateName": "PA",
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"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "252-395-1500",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "2301 JOHN F KENNEDY BLVD APT 605",
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"PracticeLocationAddressCityName": "PHILADELPHIA",
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"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "09/04/2026",
"LastUpdateDate": "09/04/2026",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MORRIS",
"AuthorizedOfficialFirstName": "JALI",
"AuthorizedOfficialMiddleName": "MICHELLE",
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"AuthorizedOfficialCredential": "OTR/L",
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"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "225X00000X",
"TaxonomyName": "Occupational Therapist",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}