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General NPI Number Information
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NPI Number | 1366460800
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Entity Type | Individual
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Provider Name | MICHAEL BRUCE O'DONNELL SR. MA CCC-AUDIOLOGY
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Gender | Male
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Dates
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Enumeration Date | 07/17/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 2525 FIFTH AVE SOUTH SUITE 2
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City | ESCANABA
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State | MI
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Zip | 49829-1204
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Country | US
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Telephone | 906-786-5147
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Fax | 906-786-0660
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Provider Business Mailing Address
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Address Line | 2525 FIFTH AVE SOUTH #2
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City | ESCANABA
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State | MI
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Zip | 49829-1204
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Country | US
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Telephone | 906-786-5147
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Fax | 906-786-0660
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 237600000X
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Taxonomy Name | Audiologist-Hearing Aid Fitter
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License Number | 1601000117
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License Number State | MI
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