MEDICARE: MR. DOUGLAS P LIVINGSTONE O.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225XH1200X	Hand Occupational Therapist	48	MT

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	P00134072	OTHER	MT	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000066070	OTHER	MT	BLUE CROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	810347861006	OTHER	MT	EBMS
5	810347861	OTHER	MT	CHAMPUS
6	0141385	OTHER	MT	WASHINGTON L & I

General Provider Information

NPI Number	:	1235171851
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DOUGLAS P LIVINGSTONE O.T.

Provider Business Mailing Address
First Line	:	500 15TH AVE S
Second Line	:	SUITE 1
City	:	GREAT FALLS
State	:	MT
Zip	:	59405-4324
Country	:	US
Telephone Number	:	406-455-3650
Fax Number	:	406-455-3650

Provider Business Practice Location Address
First Line	:	500 15TH AVE S
Second Line	:	SUITE 1
City	:	GREAT FALLS
State	:	MT
Zip	:	59405-4324
Country	:	US
Telephone Number	:	406-455-3650
Fax Number	:	406-455-3650

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/11/2006
Last Update Date	:	05/29/2008

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Directions to “ MR. DOUGLAS P LIVINGSTONE O.T.” Practice Location

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