MEDICARE: EASTER SEALS TRISTATE, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	251C00000X	Developmentally Disabled Services Day Training Agency
2	225X00000X	Occupational Therapist
3	235Z00000X	Speech-Language Pathologist
4	225100000X	Physical Therapist

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	:	1417497223
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EASTER SEALS TRISTATE, LLC

Provider Business Mailing Address
First Line	:	2901 GILBERT AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45206-1211
Country	:	US
Telephone Number	:	513-281-2316
Fax Number	:

Provider Business Practice Location Address
First Line	:	2840 MEIROSE AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45206
Country	:	US
Telephone Number	:	513-281-2316
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	MS. PAM GREEN
Credential	:
Telephone Number	:	513-281-2316

Provider Enumeration Date	:	02/27/2017
Last Update Date	:	07/21/2023

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Directions to “EASTER SEALS TRISTATE, LLC ” Practice Location

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