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General NPI Number Information
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NPI Number | 1356045058
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Entity Type | Organization
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Legal Business Name | EASTERSEALS NORTHEAST CENTRAL FLORIDA, INC.
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Dates
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Enumeration Date | 03/28/2023
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Last Update Date | 03/07/2025
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Provider Practice Location Address
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Address Line | 3804 PIONEER TRL
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City | NEW SMYRNA BEACH
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State | FL
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Zip | 32168-8784
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Country | US
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Telephone | 386-255-4568
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Fax | 386-258-7677
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Provider Business Mailing Address
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Address Line | 1219 DUNN AVE
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City | DAYTONA BEACH
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State | FL
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Zip | 32114-2405
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Country | US
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Telephone | 386-944-7805
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MARIA MONACO
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Credential |
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Telephone | 386-255-4568
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QD1600X
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Taxonomy Name | Developmental Disabilities Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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