# TRIPLE MOON THERAPY LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1184336745
- **Authorized official:** DR. COURTNEY LIVAUDAIS OTD, OTR/L (OWNER)
- **Authorized official phone:** (503) 549-1103

## Contact information

- **Practice address:** 5751 N VANCOUVER AVE, PORTLAND, OR 97217-2450
- **Practice address phone:** (503) 549-1103
- **Mailing address:** PO BOX 1111, PORTLAND, OR 97207-1111

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225X00000X | Occupational Therapist | — | NULL | Yes |
| 225X00000X | Occupational Therapist | — | — | Yes |

## Other

- **Enumeration date:** 12/15/2022
- **Last updated:** 12/15/2022