Healthcare Provider Details

I. General information

NPI: 1952457988
Provider Name (Legal Business Name): EASTERSEALS OF NORTHEAST OHIO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 05/19/2025
Certification Date: 05/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

299 EDWARDS ST
YOUNGSTOWN OH
44502-1504
US

IV. Provider business mailing address

299 EDWARDS ST
YOUNGSTOWN OH
44502-1504
US

V. Phone/Fax

Practice location:
  • Phone: 330-743-1168
  • Fax: 330-743-1616
Mailing address:
  • Phone: 330-743-1168
  • Fax: 330-743-1616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateOH
# 5
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateOH

VIII. Authorized Official

Name: MRS. JODY KLASE
Title or Position: CEO
Credential:
Phone: 330-743-1168