Provider Demographics
NPI:1194894212
Name:LIVINGSTON, KATHI (OTR)
Entity type:Individual
Prefix:MS
First Name:KATHI
Middle Name:
Last Name:LIVINGSTON
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 OXBOW CREEK
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653
Mailing Address - Country:US
Mailing Address - Phone:949-929-5092
Mailing Address - Fax:949-831-2975
Practice Address - Street 1:23232 PERALTA
Practice Address - Street 2:STE # 113 PACIFIC THERAPEUTC SERVICES INC
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653
Practice Address - Country:US
Practice Address - Phone:949-929-5092
Practice Address - Fax:949-831-2975
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAWOT3157208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW0T3157AMedicare ID - Type Unspecified