Provider Demographics
NPI:1235689878
Name:WOOTEN, ALYCE (CERTIFIED HAIR LOSS)
Entity Type:Individual
Prefix:
First Name:ALYCE
Middle Name:
Last Name:WOOTEN
Suffix:
Gender:F
Credentials:CERTIFIED HAIR LOSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1308 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17102-1969
Mailing Address - Country:US
Mailing Address - Phone:717-231-5599
Mailing Address - Fax:
Practice Address - Street 1:1308 N 3RD ST
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17102-1969
Practice Address - Country:US
Practice Address - Phone:717-231-5599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-06
Last Update Date:2016-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management