Individual provider Active NPI

Tammy Sue Odell, MA CCC/SLP

  • Speech-Language Pathologist
  • Kitty Hawk, NC
National Provider Identifier
1457592891
Registry record updated Mar 16, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
7041 Issued in NC
Practice address
4814 Lunar Dr
Kitty Hawk, NC 27949-3937
Phone
(252) 216-5746
Fax
(252) 261-6630
NPI assigned
Mar 16, 2009
Last updated
Mar 16, 2009By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 16, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X 7041 NC Primary

Addresses

Primary practice location

4814 Lunar Dr
Kitty Hawk, NC 27949-3937

Mailing address

4814 Lunar Dr
Kitty Hawk, NC 27949-3937
Phone (252) 216-5746

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Master of Arts

State licenses

LicenseStateTypeSpecialty
7041NCMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Outer Banks Speech and Language PLLC Speech-Language Pathologist Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1237161600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1237161600000",
    "number": "1457592891",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4814 LUNAR DR",
            "city": "KITTY HAWK",
            "state": "NC",
            "postal_code": "279493937",
            "telephone_number": "252-216-5746",
            "fax_number": "252-261-6630"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4814 LUNAR DR",
            "city": "KITTY HAWK",
            "state": "NC",
            "postal_code": "279493937",
            "telephone_number": "252-216-5746",
            "fax_number": "252-261-6630"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ODELL",
        "first_name": "TAMMY",
        "middle_name": "SUE",
        "credential": "MA CCC/SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-03-16",
        "last_updated": "2009-03-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NC",
            "license": "7041",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kitty Hawk, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.