Provider Demographics
NPI:1356649040
Name:LIVINGSTON, DIANE
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:LIVINGSTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7320 SW HUNZIKER ST
Mailing Address - Street 2:203
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-8283
Mailing Address - Country:US
Mailing Address - Phone:503-443-1019
Mailing Address - Fax:503-443-1012
Practice Address - Street 1:7320 SW HUNZIKER ST
Practice Address - Street 2:203
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-8283
Practice Address - Country:US
Practice Address - Phone:503-443-1019
Practice Address - Fax:503-443-1012
Is Sole Proprietor?:No
Enumeration Date:2011-03-04
Last Update Date:2011-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1049170225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist