Provider Demographics
NPI:1922413376
Name:LOW VISION REHABILITATION IN NEW MEXICO LLC
Entity Type:Organization
Organization Name:LOW VISION REHABILITATION IN NEW MEXICO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:COBY
Authorized Official - Middle Name:L
Authorized Official - Last Name:LIVINGSTONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-259-3672
Mailing Address - Street 1:303 E BUENA VISTA ST
Mailing Address - Street 2:APT 5
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-2675
Mailing Address - Country:US
Mailing Address - Phone:505-259-3672
Mailing Address - Fax:
Practice Address - Street 1:303 E BUENA VISTA ST
Practice Address - Street 2:APT 5
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-2675
Practice Address - Country:US
Practice Address - Phone:505-259-3672
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-24
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3146171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty