Provider Demographics
NPI:1639669062
Name:OMANA, CURTIS (RBT)
Entity Type:Individual
Prefix:
First Name:CURTIS
Middle Name:
Last Name:OMANA
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1497 FAIRWAY DR APT 302
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-9108
Mailing Address - Country:US
Mailing Address - Phone:630-248-0145
Mailing Address - Fax:
Practice Address - Street 1:1497 FAIRWAY DR APT 302
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-9108
Practice Address - Country:US
Practice Address - Phone:630-248-0145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-10
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL18-47097106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician