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General NPI Number Information
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NPI Number | 1407452667
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Entity Type | Organization
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Legal Business Name | THE HAIR LADY LLC, KATHERINE FAGAN
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Dates
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Enumeration Date | 12/11/2020
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Last Update Date | 12/11/2020
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Provider Practice Location Address
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Address Line | 2428 SETTER RUN LN
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City | STATE COLLEGE
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State | PA
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Zip | 16801-2577
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Country | US
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Telephone | 814-954-0143
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Fax |
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Provider Business Mailing Address
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Address Line | 2428 SETTER RUN LN
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City | STATE COLLEGE
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State | PA
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Zip | 16801-2577
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Country | US
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Telephone | 814-954-0143
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. KATHERINE ANNE FAGAN
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Credential |
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Telephone | 814-954-0143
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1744P3200X
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Taxonomy Name | Prosthetics Case Management
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License Number |
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License Number State |
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