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General NPI Number Information
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NPI Number | 1467434795
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Entity Type | Organization
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Legal Business Name | EASTER SEALS - UCP
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Dates
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Enumeration Date | 11/14/2005
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Last Update Date | 02/26/2024
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Provider Practice Location Address
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Address Line | 507 E ARMSTRONG AVE
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City | PEORIA
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State | IL
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Zip | 61603-3201
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Country | US
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Telephone | 309-686-1777
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Fax | 309-686-7722
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Provider Business Mailing Address
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Address Line | 507 E ARMSTRONG AVE
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City | PEORIA
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State | IL
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Zip | 61603-3201
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Country | US
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Telephone | 309-686-1177
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Fax | 309-686-7722
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Authorized Official
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Title or Position | PRESIDENT
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Name | MELISSA RIDDLE
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Credential | CPA, CGMA
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Telephone | 309-686-1177
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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 | 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 #3
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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Taxonomy #6
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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 #7
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Taxonomy Code | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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License Number |
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License Number State |
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