{
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"FirstLineMailingAddress": "2270 INKE RD",
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"MailingAddressCityName": "RICHMOND",
"MailingAddressStateName": "IN",
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"MailingAddressCountryCode": "US",
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"MailingAddressFaxNumber": "833-523-2388",
"FirstLinePracticeLocationAddress": "2270 INKE RD",
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"PracticeLocationAddressCityName": "RICHMOND",
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"PracticeLocationAddressFaxNumber": "833-523-2388",
"EnumerationDate": "10/31/2024",
"LastUpdateDate": "11/04/2024",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "PIERSON",
"AuthorizedOfficialFirstName": "STEPHANIE",
"AuthorizedOfficialMiddleName": "NICHOLE",
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"AuthorizedOfficialCredential": "MS, OTR, DRP",
"AuthorizedOfficialTelephoneNumber": "765-228-2219",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "225XR0403X",
"TaxonomyName": "Driving and Community Mobility Occupational Therapist",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"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."
}
}
}
}