1538201496 NPI number — MS. COBY L LIVINGSTONE OTR/L

Table of content: MS. COBY L LIVINGSTONE OTR/L (NPI 1538201496)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538201496 NPI number — MS. COBY L LIVINGSTONE OTR/L

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LIVINGSTONE
Provider First Name:
COBY
Provider Middle Name:
L
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
OTR/L
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BACKOFF
Provider Other First Name:
COBY
Provider Other Middle Name:
L
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
OTR
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1538201496
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/18/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
303 E BUENA VISTA ST
Provider Second Line Business Mailing Address:
SUITE 5
Provider Business Mailing Address City Name:
SANTA FE
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87505-2675
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-259-3672
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
303 E BUENA VISTA ST
Provider Second Line Business Practice Location Address:
SUITE 5
Provider Business Practice Location Address City Name:
SANTA FE
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87505-2675
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-259-3672
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/13/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X , with the licence number:  OT#0655 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3146 . This is a "NM OCCUPATIONAL THERAPY LICENSE" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: OT#0655 . This is a "STATE LICENSE" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 1585 . This is a "OCCUPATIONAL THERAPIST" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 5515 . This is a "CERTIFIED VISION REHABILITATION THERAPIST" identifier . This identifiers is of the category "OTHER".