Provider Demographics
NPI:1518076025
Name:DELSIGNORE, SANDRA JEAN (MT)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:JEAN
Last Name:DELSIGNORE
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 OAKRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-3540
Mailing Address - Country:US
Mailing Address - Phone:330-726-6778
Mailing Address - Fax:
Practice Address - Street 1:908 SAHARA TRL
Practice Address - Street 2:SUITE 1
Practice Address - City:POLAND
Practice Address - State:OH
Practice Address - Zip Code:44514-3667
Practice Address - Country:US
Practice Address - Phone:330-718-6447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.010964225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist