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1922491679 NPI number — ALICIA KOTHEIMER EDMISTON MS, OTR/L

NPI Number: 1922491679
Health Care Provider/Practitioner: ALICIA KOTHEIMER EDMISTON MS, OTR/L

Information about “1922491679” NPI (ALICIA KOTHEIMER EDMISTON MS, OTR/L) exists in 1922491679 in HTML format HTML  |  1922491679 in plain Text format TXT  |  1922491679 in PDF (Portable Document Format) PDF  |  1922491679 in an XML format XML  formats.

NPI Number : 1922491679 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1922491679",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "EDMISTON",
    "FirstName": "ALICIA",
    "MiddleName": "KOTHEIMER",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "MS, OTR/L",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "200 DAISY LN",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "LOUISVILLE",
    "MailingAddressStateName": "KY",
    "MailingAddressPostalCode": "40243-1402",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "502-693-7037",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "4121 SHELBYVILLE RD",
    "SecondLinePracticeLocationAddress": "SUITE 7",
    "PracticeLocationAddressCityName": "LOUISVILLE",
    "PracticeLocationAddressStateName": "KY",
    "PracticeLocationAddressPostalCode": "40207-3205",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "502-893-1380",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "03/05/2015",
    "LastUpdateDate": "07/28/2015",
    "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": "KY-R5700",
        "LicenseNumberStateCode": "KY",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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