{
"Npi": {
"NPI": "1992313449",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "CRAYMER",
"FirstName": "MALINDA",
"MiddleName": "JO",
"NamePrefix": "MRS.",
"NameSuffix": null,
"Credential": "COTA/L",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "CRAYMER",
"OtherFirstName": "MALINDA",
"OtherMiddleName": "JO",
"OtherNamePrefix": "MRS.",
"OtherNameSuffix": null,
"OtherCredential": "COTA/L",
"OtherLastNameTypeCode": "2",
"FirstLineMailingAddress": "SELECT REHAB LLC",
"SecondLineMailingAddress": "2600 COMPASS RD",
"MailingAddressCityName": "GLENVIEW",
"MailingAddressStateName": "IL",
"MailingAddressPostalCode": "60026",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "616-638-7528",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "900 S BEACON BLVD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "GRAND HAVEN",
"PracticeLocationAddressStateName": "MI",
"PracticeLocationAddressPostalCode": "49417-2146",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "616-296-7300",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "07/21/2020",
"LastUpdateDate": "07/21/2020",
"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": "224ZL0004X",
"TaxonomyName": "Low Vision Occupational Therapy Assistant",
"LicenseNumber": "5202002444",
"LicenseNumberStateCode": "MI",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "224Z00000X",
"TaxonomyName": "Occupational Therapy Assistant",
"LicenseNumber": "5202002444",
"LicenseNumberStateCode": "MI",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}