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General NPI Number Information
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NPI Number | 1699944793
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Entity Type | Organization
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Legal Business Name | LIVEIT, LLC
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Dates
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Enumeration Date | 02/22/2008
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Last Update Date | 03/31/2010
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Provider Practice Location Address
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Address Line | 1018 MAIN ST SUITE B
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City | OSAGE BEACH
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State | MO
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Zip | 65065-3033
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Country | US
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Telephone | 573-348-6767
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Fax | 573-348-6767
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Provider Business Mailing Address
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Address Line | 1018 MAIN ST SUITE B
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City | OSAGE BEACH
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State | MO
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Zip | 65065-3033
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Country | US
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Telephone | 573-348-6767
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Fax | 573-348-6767
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Authorized Official
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Title or Position | PRESIDENT
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Name | SUSAN E MITCHELL
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Credential | C.PED
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Telephone | 573-348-6767
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number | CPED2175
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License Number State | MO
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