Provider Demographics
NPI:1235546912
Name:HAAGEN, LORI (LMT, MMP)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:HAAGEN
Suffix:
Gender:F
Credentials:LMT, MMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1031 PENN ST
Mailing Address - Street 2:
Mailing Address - City:OBERLIN
Mailing Address - State:PA
Mailing Address - Zip Code:17113-1625
Mailing Address - Country:US
Mailing Address - Phone:717-576-1463
Mailing Address - Fax:
Practice Address - Street 1:3270 FULLING MILL RD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:PA
Practice Address - Zip Code:17057-3173
Practice Address - Country:US
Practice Address - Phone:717-576-1463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-15
Last Update Date:2014-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMSG002450225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist