Provider Demographics
NPI:1073839395
Name:LIVIAN, LISA (OT)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:LIVIAN
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 UPPER RAGSDALE DR
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-5730
Mailing Address - Country:US
Mailing Address - Phone:831-754-0833
Mailing Address - Fax:831-754-4358
Practice Address - Street 1:919 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93906-3912
Practice Address - Country:US
Practice Address - Phone:831-754-0833
Practice Address - Fax:831-754-4358
Is Sole Proprietor?:No
Enumeration Date:2010-04-12
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT 6541225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist