Provider Demographics
NPI:1720732449
Name:LIVENGOOD, BREYLIN RAE (MOTR/L)
Entity Type:Individual
Prefix:
First Name:BREYLIN
Middle Name:RAE
Last Name:LIVENGOOD
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:802 S GARFIELD RD APT K302
Mailing Address - Street 2:
Mailing Address - City:AIRWAY HEIGHTS
Mailing Address - State:WA
Mailing Address - Zip Code:99001-9107
Mailing Address - Country:US
Mailing Address - Phone:425-525-8937
Mailing Address - Fax:
Practice Address - Street 1:6710 N COUNTRY HOMES BLVD
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208-4337
Practice Address - Country:US
Practice Address - Phone:509-487-2958
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-10
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist