Provider Demographics
NPI:1144479551
Name:O'DONNELL, TARA C
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:C
Last Name:O'DONNELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9800B MCKNIGHT ROAD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15237
Mailing Address - Country:US
Mailing Address - Phone:412-366-3471
Mailing Address - Fax:413-364-6160
Practice Address - Street 1:9104 BABCOCK BLVD
Practice Address - Street 2:SUITE 3107
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15237-5818
Practice Address - Country:US
Practice Address - Phone:412-366-5278
Practice Address - Fax:412-364-1785
Is Sole Proprietor?:No
Enumeration Date:2008-09-10
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAT006016231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist