Provider Demographics
NPI:1538201496
Name:LIVINGSTONE, COBY L (OTR/L)
Entity type:Individual
Prefix:MS
First Name:COBY
Middle Name:L
Last Name:LIVINGSTONE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MS
Other - First Name:COBY
Other - Middle Name:L
Other - Last Name:BACKOFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:303 E BUENA VISTA ST
Mailing Address - Street 2:SUITE 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:SUITE 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:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2014-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOT#0655225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM3146OtherNM OCCUPATIONAL THERAPY LICENSE
AZOT#0655OtherSTATE LICENSE
OK1585OtherOCCUPATIONAL THERAPIST
5515OtherCERTIFIED VISION REHABILITATION THERAPIST