Healthcare Provider Details

I. General information

NPI: 1093884926
Provider Name (Legal Business Name): EASTER SEAL REHABILITATION CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 10/11/2023
Certification Date: 10/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 TOMPKINS ST
WATERBURY CT
06708-1417
US

IV. Provider business mailing address

22 TOMPKINS ST
WATERBURY CT
06708-1417
US

V. Phone/Fax

Practice location:
  • Phone: 203-754-5141
  • Fax: 203-757-1198
Mailing address:
  • Phone: 203-754-5141
  • Fax: 203-757-1198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number
License Number State

VIII. Authorized Official

Name: MRS. LORAINE SHEA
Title or Position: PRESIDENT
Credential:
Phone: 203-754-5141