Provider Demographics
NPI:1407452667
Name:THE HAIR LADY LLC, KATHERINE FAGAN
Entity Type:Organization
Organization Name:THE HAIR LADY LLC, KATHERINE FAGAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:FAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-954-0143
Mailing Address - Street 1:2428 SETTER RUN LN
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16801-2577
Mailing Address - Country:US
Mailing Address - Phone:814-954-0143
Mailing Address - Fax:
Practice Address - Street 1:2428 SETTER RUN LN
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-2577
Practice Address - Country:US
Practice Address - Phone:814-954-0143
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-11
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case ManagementGroup - Single Specialty