Provider Demographics
NPI:1326590589
Name:LIVINGSTON, DIANE (OTR/L)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:LIVINGSTON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2315 W D ST
Mailing Address - Street 2:
Mailing Address - City:NORTH PLATTE
Mailing Address - State:NE
Mailing Address - Zip Code:69101-4944
Mailing Address - Country:US
Mailing Address - Phone:308-534-0174
Mailing Address - Fax:
Practice Address - Street 1:301 W F ST
Practice Address - Street 2:
Practice Address - City:NORTH PLATTE
Practice Address - State:NE
Practice Address - Zip Code:69101-5201
Practice Address - Country:US
Practice Address - Phone:308-696-3317
Practice Address - Fax:308-535-7119
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-03
Last Update Date:2016-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE160225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist