Healthcare Provider Details

I. General information

NPI: 1912393950
Provider Name (Legal Business Name): AMY E. O'DONNELL M.ED., CCC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2015
Last Update Date: 04/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3318 S. ALAMEDA
CORPUS CHRISTI TX
78411
US

IV. Provider business mailing address

3318 S. ALAMEDA
CORPUS CHRISTI TX
78411
US

V. Phone/Fax

Practice location:
  • Phone: 361-854-7000
  • Fax: 361-814-2685
Mailing address:
  • Phone: 361-854-7000
  • Fax: 361-814-2685

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number80642
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: