Provider Demographics
NPI:1114188133
Name:CONATSER, ANDREA D (DI)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:D
Last Name:CONATSER
Suffix:
Gender:F
Credentials:DI
Other - Prefix:
Other - First Name:GATEWAY
Other - Middle Name:
Other - Last Name:DEVELOPMENTAL INTERVENTION
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA
Mailing Address - Street 1:5455 W HIGHWAY 60
Mailing Address - Street 2:
Mailing Address - City:OWINGSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40360-9027
Mailing Address - Country:US
Mailing Address - Phone:859-585-8525
Mailing Address - Fax:859-498-5198
Practice Address - Street 1:5455 W HIGHWAY 60
Practice Address - Street 2:
Practice Address - City:OWINGSVILLE
Practice Address - State:KY
Practice Address - Zip Code:40360-9027
Practice Address - Country:US
Practice Address - Phone:859-585-8525
Practice Address - Fax:859-498-5198
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY02852OtherKY EARLY INTERVENTION SYSTEM PROVIDER ID#