{
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"FirstLineMailingAddress": "3836 BERLEIGH HILL CT",
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"MailingAddressCityName": "BURTONSVILLE",
"MailingAddressStateName": "MD",
"MailingAddressPostalCode": "20866-1392",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "301-219-7051",
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"FirstLinePracticeLocationAddress": "4954 N PALMER RD BLDG 19",
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"PracticeLocationAddressCityName": "BETHESDA",
"PracticeLocationAddressStateName": "MD",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "301-319-4225",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "02/13/2007",
"LastUpdateDate": "04/03/2023",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
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"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "225XP0200X",
"TaxonomyName": "Pediatric Occupational Therapist",
"LicenseNumber": "04680",
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"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}