Individual
JOEL BRYNN LIVINGSTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
COTA
Contact information
Practice address
602 SE WALLOCK ST, LAWTON, OK 73501-5444
(580) 355-1512
(580) 355-1513
Mailing address
522 E. EVANS, APACHE, OK 73006
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OA584
OK
Other
Enumeration date
05/23/2007
Last updated
07/08/2007
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