Provider Demographics
NPI:1922446251
Name:SIGNORELLI, KRISTEN ELIZABETH (OT)
Entity Type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:ELIZABETH
Last Name:SIGNORELLI
Suffix:
Gender:F
Credentials:OT
Other - Prefix:MRS
Other - First Name:KRISTEN
Other - Middle Name:ELIZABETH
Other - Last Name:KONKUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:1502 SMOKETREE DR
Mailing Address - Street 2:
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-3245
Mailing Address - Country:US
Mailing Address - Phone:817-480-4818
Mailing Address - Fax:
Practice Address - Street 1:1101 KELLER PKWY
Practice Address - Street 2:
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-3614
Practice Address - Country:US
Practice Address - Phone:817-562-3111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-09
Last Update Date:2013-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX104599225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics