Provider Demographics
NPI:1386370617
Name:CONNOR, KILEY ELIZABETH
Entity type:Individual
Prefix:
First Name:KILEY
Middle Name:ELIZABETH
Last Name:CONNOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 N 4TH ST STE 1
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:SD
Mailing Address - Zip Code:57401-2727
Mailing Address - Country:US
Mailing Address - Phone:605-377-5930
Mailing Address - Fax:
Practice Address - Street 1:701 N 4TH ST STE 1
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:SD
Practice Address - Zip Code:57401-2727
Practice Address - Country:US
Practice Address - Phone:605-377-5930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-28
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDMT11611225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist