Provider Demographics
NPI:1790815298
Name:OATES, TAMARA (SLP)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:
Last Name:OATES
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9801 ACADEMY HILLS DR NE
Mailing Address - Street 2:HUBERT HUMPHREY ES
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-1311
Mailing Address - Country:US
Mailing Address - Phone:505-821-4981
Mailing Address - Fax:
Practice Address - Street 1:9801 ACADEMY HILLS DR NE
Practice Address - Street 2:HUBERT HUMPHREY ES
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-1311
Practice Address - Country:US
Practice Address - Phone:505-821-4981
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2592235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM73765Medicaid