=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538201496
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | COBY L LIVINGSTONE OTR/L
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/13/2007
-----------------------------------------------------
Last Update Date | 07/18/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 303 E BUENA VISTA ST SUITE 5
-----------------------------------------------------
City | SANTA FE
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87505-2675
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-259-3672
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 303 E BUENA VISTA ST SUITE 5
-----------------------------------------------------
City | SANTA FE
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87505-2675
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-259-3672
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | OT#0655
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------