Organization
WONDROUS KIDS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ADAM BRAZEAL (OFFICE MANAGER)
(918) 231-5784
Entity
Organization
Contact information
Practice address
1211 NEW PRUE RD, SAND SPRINGS, OK 74063-9024
(918) 231-5784
Mailing address
1211 NEW PRUE RD, SAND SPRINGS, OK 74063-9024
(918) 694-2693
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
—
—
2251P0200X
Pediatric Physical Therapist
—
—
225200000X
Physical Therapy Assistant
—
—
225XP0200X
Pediatric Occupational Therapist
Primary
—
—
235Z00000X
Speech-Language Pathologist
—
—
Other
Enumeration date
02/01/2021
Last updated
02/01/2021
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