{
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"IsOrgSubpart": "N",
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"OtherLastName": null,
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"FirstLineMailingAddress": "4610 S 73RD ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "TACOMA",
"MailingAddressStateName": "WA",
"MailingAddressPostalCode": "98409-1417",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "253-426-3763",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "208 WILKES ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "STEILACOOM",
"PracticeLocationAddressStateName": "WA",
"PracticeLocationAddressPostalCode": "98388-2122",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "253-426-3763",
"PracticeLocationAddressFaxNumber": "253-260-1613",
"EnumerationDate": "03/04/2025",
"LastUpdateDate": "05/19/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "WEBSTER",
"AuthorizedOfficialFirstName": "KELLY JO",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "LICENSED MASSAGE THERAPIST, OWNER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "LMT",
"AuthorizedOfficialTelephoneNumber": "253-426-3763",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "225700000X",
"TaxonomyName": "Massage Therapist",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"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."
}
}
}
}