Healthcare Provider Details

I. General information

NPI: 1417142761
Provider Name (Legal Business Name): EASTER SEALS RHODE ISLAND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2007
Last Update Date: 01/06/2020
Certification Date: 01/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 PHILLIPS ST UNIT 103
NORTH KINGTOWN RI
02852-5149
US

IV. Provider business mailing address

633 THIRD AVENUE 6TH FLOOR
NEW YORK NY
10017-6701
US

V. Phone/Fax

Practice location:
  • Phone: 401-284-1000
  • Fax: 401-284-1006
Mailing address:
  • Phone: 212-727-4270
  • Fax: 212-727-4374

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. CAROL KHOURY
Title or Position: CFO
Credential:
Phone: 212-727-4270