Provider Demographics
NPI:1023216728
Name:FOX-FAIR, JUDITH L (RAC)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:L
Last Name:FOX-FAIR
Suffix:
Gender:F
Credentials:RAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:PA
Mailing Address - Zip Code:16229-1027
Mailing Address - Country:US
Mailing Address - Phone:724-448-4437
Mailing Address - Fax:
Practice Address - Street 1:1170 WILDLIFE LODGE RD
Practice Address - Street 2:
Practice Address - City:LOWER BURRELL
Practice Address - State:PA
Practice Address - Zip Code:15068-3562
Practice Address - Country:US
Practice Address - Phone:724-339-0370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAKO000602171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist