Odyssey Therapeutics

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

Legal business name

ODYSSEY THERAPEUTICS

Practice address

15111 105TH Avenue CT E
Ste. 2
Puyallup, WA 98374-3747

Phone

(360) 820-0954

Fax

(253) 881-1017

NPI assigned

Dec 21, 2015

Organization subpart

No

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

Authorized official

Name

Robert Shields, MS, CCC-SLP

Title

Owner/Administrator/Therapist

Phone

(360) 820-0954

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1450656000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1464825600000",
    "number": "1831554641",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15018 113TH AVE E",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983743408",
            "telephone_number": "360-820-0954",
            "fax_number": "253-881-1017"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15111 105TH AVENUE CT E",
            "address_2": "STE. 2",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983743747",
            "telephone_number": "360-820-0954",
            "fax_number": "253-881-1017"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ODYSSEY THERAPEUTICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-12-21",
        "last_updated": "2016-06-02",
        "status": "A",
        "authorized_official_last_name": "SHIELDS",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "OWNER/ADMINISTRATOR/THERAPIST",
        "authorized_official_telephone_number": "360-820-0954",
        "authorized_official_credential": "MS, CCC-SLP"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Speech-Language Pathologist in Puyallup, WA
• Providers in Puyallup, WA by specialty
• Speech-Language Pathologist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2016; 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.