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1861696148 NPI number — KATHLEEN C ODIN PTA

NPI Number: 1861696148
Health Care Provider/Practitioner: KATHLEEN C ODIN PTA

Information about “1861696148” NPI (KATHLEEN C ODIN PTA) exists in 1861696148 in HTML format HTML  |  1861696148 in plain Text format TXT  |  1861696148 in PDF (Portable Document Format) PDF  |  1861696148 in an XML format XML  formats.

NPI Number : 1861696148 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1861696148",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "ODIN",
    "FirstName": "KATHLEEN",
    "MiddleName": "C",
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": "PTA",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "DRAVELING",
    "OtherFirstName": "KATHLEEN",
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "8780 RAINIER ALCOVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "WOODBURY",
    "MailingAddressStateName": "MN",
    "MailingAddressPostalCode": "55125",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "651-428-3902",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "2727 N VICTORIA",
    "SecondLinePracticeLocationAddress": "LAKERIDGE HC CENTER AEGIS THERAPIES",
    "PracticeLocationAddressCityName": "ROSEVILLE",
    "PracticeLocationAddressStateName": "MN",
    "PracticeLocationAddressPostalCode": "55113",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "651-483-5431",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "06/12/2007",
    "LastUpdateDate": "07/08/2007",
    "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": "225200000X",
        "TaxonomyName": "Physical Therapy Assistant",
        "LicenseNumber": "250019",
        "LicenseNumberStateCode": "WI",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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