{
"Npi": {
"NPI": "1841945557",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "KENNEDY",
"FirstName": "ALLIE",
"MiddleName": "LYNN",
"NamePrefix": "MRS.",
"NameSuffix": null,
"Credential": "OTR/L",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "MCCONNELL",
"OtherFirstName": "ALLIE",
"OtherMiddleName": "LYNN",
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "5384 LAWSON RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "GAINESVILLE",
"MailingAddressStateName": "GA",
"MailingAddressPostalCode": "30506-2721",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "678-591-4631",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "4875 HOG MOUNTAIN RD STE A",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "FLOWERY BRANCH",
"PracticeLocationAddressStateName": "GA",
"PracticeLocationAddressPostalCode": "30542-6450",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "678-828-8584",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "02/21/2022",
"LastUpdateDate": "02/21/2022",
"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": "OT008357",
"LicenseNumberStateCode": "GA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}