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General NPI Number Information
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NPI Number | 1497054316
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Entity Type | Organization
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Legal Business Name | EASTER SEAL REHABILITATION CENTER
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Dates
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Enumeration Date | 03/17/2011
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Last Update Date | 06/21/2023
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Provider Practice Location Address
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Address Line | 22 TOMPKINS ST
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City | WATERBURY
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State | CT
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Zip | 06708-1496
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Country | US
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Telephone | 203-754-5141
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Fax | 203-757-1198
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Provider Business Mailing Address
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Address Line | 22 TOMPKINS ST
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City | WATERBURY
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State | CT
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Zip | 06708-1496
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Country | US
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Telephone | 203-754-5141
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Fax | 203-757-1198
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Authorized Official
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Title or Position | CFO/COO
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Name | MR. GARY NIELSEN
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Credential |
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Telephone | 203-754-5141
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0700X
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Taxonomy Name | Hearing and Speech Clinic/Center
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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 | 332S00000X
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Taxonomy Name | Hearing Aid Equipment
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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 | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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