Healthcare Provider Details

I. General information

NPI: 1881040061
Provider Name (Legal Business Name): EASTER SEALS BAY AREA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2016
Last Update Date: 11/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1151 A STREET
HAYWARD CA
94541
US

IV. Provider business mailing address

2730 SHADELANDS DRIVE, BUILDING 10
WALNUT CREEK CA
94598
US

V. Phone/Fax

Practice location:
  • Phone: 510-300-3600
  • Fax:
Mailing address:
  • Phone: 925-266-8400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: SUSAN ARMIGER
Title or Position: PRESIDENT AND CEO
Credential:
Phone: 925-266-8400