Organization
SPECTRUM OF HOPE, LLC
Active
Other names
SOH KIDS, Soaring On Hope Pediatric Therapy and Autism Center
Organization subpart
No
Provider details
NPI number
Authorized official
JONATHAN RYAN WEDEL (COO)
(918) 984-9153
Entity
Organization
Contact information
Practice address
4908 S SHERIDAN RD, TULSA, OK 74145-5712
(918) 984-9153
Mailing address
4908 S SHERIDAN RD, TULSA, OK 74145-5712
(918) 984-9153
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
103K00000X
Behavior Analyst
—
—
103TC2200X
Clinical Child & Adolescent Psychologist
—
—
103TM1800X
Intellectual & Developmental Disabilities Psychologist
—
—
133V00000X
Registered Dietitian
—
—
133VN1004X
Pediatric Nutrition Registered Dietitian
—
—
172V00000X
Community Health Worker
—
—
224Z00000X
Occupational Therapy Assistant
—
—
225100000X
Physical Therapist
—
—
225X00000X
Occupational Therapist
—
—
225XM0800X
Mental Health Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
—
—
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200745940
—
OK
Enumeration date
10/19/2017
Last updated
01/10/2021
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