Provider Demographics
NPI:1033363973
Name:LIVINGSTON, JEREMY DAVID (CO, BOCP)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:DAVID
Last Name:LIVINGSTON
Suffix:
Gender:M
Credentials:CO, BOCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 LINDSAY LN
Mailing Address - Street 2:
Mailing Address - City:CODY
Mailing Address - State:WY
Mailing Address - Zip Code:82414-4142
Mailing Address - Country:US
Mailing Address - Phone:307-250-2443
Mailing Address - Fax:
Practice Address - Street 1:720 LINDSAY LN
Practice Address - Street 2:
Practice Address - City:CODY
Practice Address - State:WY
Practice Address - Zip Code:82414-4142
Practice Address - Country:US
Practice Address - Phone:307-250-2443
Practice Address - Fax:307-578-8820
Is Sole Proprietor?:No
Enumeration Date:2008-11-05
Last Update Date:2018-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
No224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist