Provider Demographics
NPI:1457592891
Name:ODELL, TAMMY SUE (MA CCC/SLP)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:SUE
Last Name:ODELL
Suffix:
Gender:F
Credentials:MA CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:252-261-6630
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:252-261-6630
Is Sole Proprietor?:No
Enumeration Date:2009-03-16
Last Update Date:2009-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7041235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist