Provider Demographics
NPI:1427713213
Name:CONATSER, KYRA
Entity type:Individual
Prefix:
First Name:KYRA
Middle Name:
Last Name:CONATSER
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 1:2205 E 8TH ST
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47302-3702
Mailing Address - Country:US
Mailing Address - Phone:765-625-0489
Mailing Address - Fax:765-378-9019
Practice Address - Street 1:2205 E 8TH ST
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47302-3702
Practice Address - Country:US
Practice Address - Phone:765-625-0489
Practice Address - Fax:765-378-9019
Is Sole Proprietor?:No
Enumeration Date:2021-11-05
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist