Healthcare Provider Details

I. General information

NPI: 1508180878
Provider Name (Legal Business Name): LIVINGSTON CO. R-III
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2010
Last Update Date: 03/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 WAITE ST
CHULA MO
64635-8273
US

IV. Provider business mailing address

PO BOX 40 205 WAITE STREET
CHULA MO
64635-0040
US

V. Phone/Fax

Practice location:
  • Phone: 660-639-3135
  • Fax: 660-393-2171
Mailing address:
  • Phone: 660-639-3135
  • Fax: 660-393-2171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State

VIII. Authorized Official

Name: SARA LITTRELL
Title or Position: PRINCIPAL
Credential:
Phone: 660-639-3135