Provider Demographics
NPI:1033396197
Name:OMAN, TAMRA J (CFT 14379130)
Entity Type:Individual
Prefix:
First Name:TAMRA
Middle Name:J
Last Name:OMAN
Suffix:
Gender:F
Credentials:CFT 14379130
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 W SUNNY LANE
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53546
Mailing Address - Country:US
Mailing Address - Phone:608-741-4500
Mailing Address - Fax:608-741-4502
Practice Address - Street 1:203 W SUNNY LANE
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53546
Practice Address - Country:US
Practice Address - Phone:608-741-4500
Practice Address - Fax:608-741-4516
Is Sole Proprietor?:No
Enumeration Date:2008-01-30
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14379130101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42247900Medicaid