Healthcare Provider Details

I. General information

NPI: 1417497223
Provider Name (Legal Business Name): EASTER SEALS TRISTATE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2017
Last Update Date: 07/21/2023
Certification Date: 07/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2840 MEIROSE AVE
CINCINNATI OH
45206
US

IV. Provider business mailing address

2901 GILBERT AVE
CINCINNATI OH
45206-1211
US

V. Phone/Fax

Practice location:
  • Phone: 513-281-2316
  • Fax:
Mailing address:
  • Phone: 513-281-2316
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. PAM GREEN
Title or Position: PRESIDENT/CEO
Credential:
Phone: 513-281-2316