Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | OA584 | OK |
NPI | 1023228517 |
---|---|
Provider Name | Joel Brynn Livingston |
First Address | Apache, OK 73006 |
Second Address | Lawton, OK 73501-5444 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2007 |
Last Update Date | 08/07/2007 |