Provider Demographics
NPI:1972891224
Name:KIRBY, TERESA GIANSANTI (OTR, LOT)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:GIANSANTI
Last Name:KIRBY
Suffix:
Gender:F
Credentials:OTR, LOT
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:G
Other - Last Name:KIRBY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTR, LOT
Mailing Address - Street 1:4903 TOMAHAWK TRL.
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-1544
Mailing Address - Country:US
Mailing Address - Phone:512-445-2632
Mailing Address - Fax:
Practice Address - Street 1:4903 TOMAHAWK TRL.
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-1544
Practice Address - Country:US
Practice Address - Phone:512-445-2632
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-20
Last Update Date:2011-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX100801225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics