Healthcare Provider Details

I. General information

NPI: 1104768514
Provider Name (Legal Business Name): EASTERSEALS FLORIDA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2026
Last Update Date: 04/06/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1802 S FISKE BLVD STE 201
ROCKLEDGE FL
32955-3007
US

IV. Provider business mailing address

125 N RIDGEWOOD AVE STE 300
DAYTONA BEACH FL
32114-3284
US

V. Phone/Fax

Practice location:
  • Phone: 321-634-3688
  • Fax:
Mailing address:
  • Phone: 386-944-7802
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: RIKESHA BLAKE
Title or Position: CFO
Credential:
Phone: 407-287-5185