Provider Demographics
NPI:1235171851
Name:LIVINGSTONE, DOUGLAS P (OT)
Entity Type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:P
Last Name:LIVINGSTONE
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 15TH AVE S
Mailing Address - Street 2:SUITE 1
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59405-4324
Mailing Address - Country:US
Mailing Address - Phone:406-455-3650
Mailing Address - Fax:406-455-3650
Practice Address - Street 1:500 15TH AVE S
Practice Address - Street 2:SUITE 1
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405-4324
Practice Address - Country:US
Practice Address - Phone:406-455-3650
Practice Address - Fax:406-455-3650
Is Sole Proprietor?:No
Enumeration Date:2006-06-11
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT48225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT000066070OtherBLUE CROSS BLUE SHIELD
MT3400787Medicaid
MT810347861006OtherEBMS
MTP00134072OtherRAILROAD MEDICARE
MT810347861OtherCHAMPUS
MT0141385OtherWASHINGTON L & I
MT0141385OtherWASHINGTON L & I
MT000066070OtherBLUE CROSS BLUE SHIELD