Provider Demographics
NPI:1427460609
Name:LIVELY, GAYLE
Entity type:Individual
Prefix:
First Name:GAYLE
Middle Name:
Last Name:LIVELY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 STANLEY AVE UNIT A
Mailing Address - Street 2:
Mailing Address - City:ESTES PARK
Mailing Address - State:CO
Mailing Address - Zip Code:80517-5608
Mailing Address - Country:US
Mailing Address - Phone:970-586-4316
Mailing Address - Fax:
Practice Address - Street 1:450 STANLEY AVE UNIT A
Practice Address - Street 2:
Practice Address - City:ESTES PARK
Practice Address - State:CO
Practice Address - Zip Code:80517-5608
Practice Address - Country:US
Practice Address - Phone:970-586-4316
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-22
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORTL0003859227900000X
LALRT.000641227900000X
TX18426227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered