Provider Demographics
NPI:1356543250
Name:OUTER BANKS SPEECH AND LANGUAGE PLLC
Entity type:Organization
Organization Name:OUTER BANKS SPEECH AND LANGUAGE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:ODELL
Authorized Official - Suffix:
Authorized Official - Credentials:MA CCC SLP
Authorized Official - Phone:252-216-5746
Mailing Address - Street 1:4814 LUNAR DR
Mailing Address - Street 2:
Mailing Address - City:KITTY HAWK
Mailing Address - State:NC
Mailing Address - Zip Code:27949-3937
Mailing Address - Country:US
Mailing Address - Phone:252-216-5746
Mailing Address - Fax:252-216-5746
Practice Address - Street 1:4814 LUNAR DR
Practice Address - Street 2:
Practice Address - City:KITTY HAWK
Practice Address - State:NC
Practice Address - Zip Code:27949-3937
Practice Address - Country:US
Practice Address - Phone:252-216-5746
Practice Address - Fax:252-216-5746
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-03
Last Update Date:2008-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7041235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty