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1831495092 NPI number — RAPHAELE JACQUELINE WAGNER MS,OTR/L

NPI Number: 1831495092
Health Care Provider/Practitioner: RAPHAELE JACQUELINE WAGNER MS,OTR/L

Information about “1831495092” NPI (RAPHAELE JACQUELINE WAGNER MS,OTR/L) exists in 1831495092 in HTML format HTML  |  1831495092 in plain Text format TXT  |  1831495092 in PDF (Portable Document Format) PDF  |  1831495092 in an XML format XML  formats.

NPI Number : 1831495092 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1831495092",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "WAGNER",
    "FirstName": "RAPHAELE",
    "MiddleName": "JACQUELINE",
    "NamePrefix": "MISS",
    "NameSuffix": null,
    "Credential": "MS,OTR/L",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "LATAILLADE",
    "OtherFirstName": "RAPHAELE",
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "MS,OTR/L",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "1131 COVERBROOK LN",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SEBASTIAN",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "32958-5949",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "954-593-5884",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "5690 F COACH HOUSE CIRCLE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "BOCA RATON",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "33486",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "561-368-3008",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "02/07/2011",
    "LastUpdateDate": "08/17/2020",
    "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": "OT10833",
        "LicenseNumberStateCode": "FL",
        "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."
      }
    }
  }
}
                
            

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