MEDICARE: EASTER SEALS SOUTHWEST FLORIDA, NOKOMIS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	261Q00000X	Clinic/Center
2	225100000X	Physical Therapist
3	225X00000X	Occupational Therapist
4	235Z00000X	Speech-Language Pathologist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043815160
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EASTER SEALS SOUTHWEST FLORIDA, NOKOMIS

Provider Business Mailing Address
First Line	:	350 BRADEN AVE
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34243-2001
Country	:	US
Telephone Number	:	941-355-7637
Fax Number	:

Provider Business Practice Location Address
First Line	:	1629 RANCH RD
Second Line	:
City	:	NOKOMIS
State	:	FL
Zip	:	34275-1708
Country	:	US
Telephone Number	:	941-355-7637
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. TOM WATERS
Credential	:
Telephone Number	:	941-355-7637

Provider Enumeration Date	:	12/04/2020
Last Update Date	:	12/07/2020

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Directions to “EASTER SEALS SOUTHWEST FLORIDA, NOKOMIS ” Practice Location

Language	Start Address	Practice Location

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