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NPI Code Detail

MEDICARE: JONATHAN WEISSBACH

MEDICARE: JONATHAN WEISSBACH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior TechnicianRBT-26-517220OK

General Provider Information

NPI Number : 1801739388
Entity Type Code : Individual
Provider Name (Legal Business Name) : JONATHAN WEISSBACH
Provider Business Mailing Address
First Line : 1200 S AIR DEPOT BLVD STE K-M
Second Line :
City : MIDWEST CITY
State : OK
Zip : 73110-4866
Country : US
Telephone Number : 405-857-8280
Fax Number :
Provider Business Practice Location Address
First Line : 1200 S AIR DEPOT BLVD STE K-M
Second Line :
City : MIDWEST CITY
State : OK
Zip : 73110-4866
Country : US
Telephone Number : 405-857-8280
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/10/2026
Last Update Date : 04/10/2026

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Directions to “ JONATHAN WEISSBACH ” Practice Location

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