Healthcare Provider Details

I. General information

NPI: 1760091037
Provider Name (Legal Business Name): EASTER SEALS SOUTHWEST FLORIDA INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2020
Last Update Date: 07/23/2020
Certification Date: 07/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 BRADEN AVE
SARASOTA FL
34243-2001
US

IV. Provider business mailing address

350 BRADEN AVE
SARASOTA FL
34243-2001
US

V. Phone/Fax

Practice location:
  • Phone: 941-355-7637
  • Fax:
Mailing address:
  • Phone: 941-355-7637
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: CHERYL WEICHERT
Title or Position: THERAPY COORDINATOR
Credential:
Phone: 941-355-7637