Healthcare Provider Details

I. General information

NPI: 1235203035
Provider Name (Legal Business Name): EASTER SEALS SOUTH FLORIDA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 09/26/2024
Certification Date: 09/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1475 NW 14TH AVE
MIAMI FL
33125-1616
US

IV. Provider business mailing address

1475 NW 14TH AVE.
MIAMI FL
33125
US

V. Phone/Fax

Practice location:
  • Phone: 305-325-0470
  • Fax: 786-422-1005
Mailing address:
  • Phone: 305-325-0470
  • Fax: 305-325-0578

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number8960
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: CAMILA ROCHA
Title or Position: PRESIDENT/CEO
Credential:
Phone: 305-547-4757