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1053311696

NPI Code Detail

MEDICARE: EASTER SEAL SOCIETY OF SUPERIOR CALIFORNIA

MEDICARE: EASTER SEAL SOCIETY OF SUPERIOR CALIFORNIA

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
1	235Z00000X	Speech-Language Pathologist
2	251C00000X	Developmentally Disabled Services Day Training Agency		CA
3	2081P0301X	Brain Injury Medicine (Physical Medicine & Rehabilitation) Physician
4	225100000X	Physical Therapist
5	225X00000X	Occupational Therapist
6	251C00000X	Developmentally Disabled Services Day Training Agency
7	252Y00000X	Early Intervention Provider Agency
8	261QA0600X	Adult Day Care Clinic/Center
9	261QD1600X	Developmental Disabilities Clinic/Center
10	261QP2000X	Physical Therapy Clinic/Center
11	261QR0400X	Rehabilitation Clinic/Center
12	208100000X	Physical Medicine & Rehabilitation Physician

General Provider Information

NPI Number	:	1053311696
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EASTER SEAL SOCIETY OF SUPERIOR CALIFORNIA

Provider Business Mailing Address
First Line	:	3205 HURLEY WAY
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95864-3853
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3205 HURLEY WAY
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95864-3853
Country	:	US
Telephone Number	:	916-485-6711
Fax Number	:	916-485-2653

Authorized Official
Title or Position	:	CFO
Name	:	HOAN NGUYEN
Credential	:
Telephone Number	:	916-485-6711

Provider Enumeration Date	:	07/26/2005
Last Update Date	:	12/07/2018

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1821226374 — MS. MARY E SHAW MA,CCC-SLP
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Directions to “EASTER SEAL SOCIETY OF SUPERIOR CALIFORNIA ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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