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 State
1	251C00000X	Developmentally Disabled Services Day Training Agency
2	261QA0600X	Adult Day Care Clinic/Center
3	235Z00000X	Speech-Language Pathologist
4	251C00000X	Developmentally Disabled Services Day Training Agency	CA
5	225100000X	Physical Therapist
6	261QD1600X	Developmental Disabilities Clinic/Center
7	261QP2000X	Physical Therapy Clinic/Center
8	225X00000X	Occupational Therapist
9	252Y00000X	Early Intervention Provider Agency
10	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	:	9812 OLD WINERY PL STE 21
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95827-1732
Country	:	US
Telephone Number	:	916-485-6711
Fax Number	:	916-679-3100

Provider Business Practice Location Address
First Line	:	9812 OLD WINERY PL STE 21
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95827-1732
Country	:	US
Telephone Number	:	916-485-6711
Fax Number	:	916-679-3100

Authorized Official
Title or Position	:	VICE PRESIDENT, PEDIATRIC SERVICES
Name	:	RENNIE T SALTZMAN
Credential	:	PT
Telephone Number	:	916-485-6711

Provider Enumeration Date	:	07/26/2005
Last Update Date	:	03/23/2026

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