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General NPI Number Information
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NPI Number | 1780048421
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Entity Type | Organization
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Legal Business Name | EASTER SEALS BAY AREA
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Dates
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Enumeration Date | 04/08/2016
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Last Update Date | 11/05/2018
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Provider Practice Location Address
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Address Line | 160 WIKIUP DRIVE, SUITE 102
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City | SANTA ROSA
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State | CA
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Zip | 95403
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Country | US
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Telephone | 707-843-3745
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Fax |
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Provider Business Mailing Address
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Address Line | 2730 SHADELANDS DRIVE, BLDG. 10
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City | WALNUT CREEK
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State | CA
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Zip | 94598
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Country | US
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Telephone | 925-266-8400
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Fax |
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Authorized Official
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Title or Position | PRESIDENT AND CEO
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Name | SUSAN ARMIGER
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Credential |
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Telephone | 925-266-8400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number |
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License Number State | CA
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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 | CA
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Taxonomy #3
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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 | CA
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