MEDICARE: EASTER SEAL SOCIETY OF SOUTH CAROLINA INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	225X00000X	Occupational Therapist
2	235Z00000X	Speech-Language Pathologist
3	261QP2000X	Physical Therapy Clinic/Center

Other Identifiers

#	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

General Provider Information

NPI Number	:	1285637785
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EASTER SEAL SOCIETY OF SOUTH CAROLINA INC

Provider Business Mailing Address
First Line	:	101 DEER RUN RD
Second Line	:
City	:	ELGIN
State	:	SC
Zip	:	29045-8605
Country	:	US
Telephone Number	:	803-422-3894
Fax Number	:	803-661-8450

Provider Business Practice Location Address
First Line	:	101 DEER RUN RD
Second Line	:
City	:	ELGIN
State	:	SC
Zip	:	29045-8605
Country	:	US
Telephone Number	:	803-422-3894
Fax Number	:	803-888-4382

Authorized Official
Title or Position	:	CENTER MANAGER
Name	:	SHAE PEAK
Credential	:	CHE
Telephone Number	:	803-212-8971

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	12/21/2022

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Directions to “EASTER SEAL SOCIETY OF SOUTH CAROLINA INC ” Practice Location

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