MEDICARE: EASTERSEALS CENTRAL AND SOUTHEAST OHIO, INC.

Medicare Provider Information

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

#	Taxonomy Code	Taxonomy
1	235Z00000X	Speech-Language Pathologist
2	251V00000X	Voluntary or Charitable Agency
3	252Y00000X	Early Intervention Provider Agency
4	253Z00000X	In Home Supportive Care Agency
5	261QA0600X	Adult Day Care Clinic/Center
6	1041C0700X	Clinical Social Worker
7	225XP0200X	Pediatric Occupational Therapist
8	261QD1600X	Developmental Disabilities Clinic/Center
9	2251P0200X	Pediatric Physical Therapist

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

NPI Number	:	1235103946
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EASTERSEALS CENTRAL AND SOUTHEAST OHIO, INC.

Provider Business Mailing Address
First Line	:	3830 TRUEMAN CT
Second Line	:
City	:	HILLIARD
State	:	OH
Zip	:	43026-2496
Country	:	US
Telephone Number	:	614-228-5523
Fax Number	:	614-228-8151

Provider Business Practice Location Address
First Line	:	3830 TRUEMAN CT
Second Line	:
City	:	HILLIARD
State	:	OH
Zip	:	43026-2496
Country	:	US
Telephone Number	:	614-228-5523
Fax Number	:	614-228-8151

Authorized Official
Title or Position	:	CONTROLLER
Name	:	JOAN JOHNSON
Credential	:
Telephone Number	:	614-228-5523

Provider Enumeration Date	:	02/17/2006
Last Update Date	:	11/24/2020