MEDICARE: EASTER SEALS SOUTHWESTERN OHIO

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251V00000X	Voluntary or Charitable Agency

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	:	1609879477
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EASTER SEALS SOUTHWESTERN OHIO

Provider Business Mailing Address
First Line	:	231 CLARK RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45215-5539
Country	:	US
Telephone Number	:	513-821-9890
Fax Number	:	513-821-9895

Provider Business Practice Location Address
First Line	:	231 CLARK RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45215-5539
Country	:	US
Telephone Number	:	513-821-9890
Fax Number	:	513-821-9895

Authorized Official
Title or Position	:	PRESIDENT & CEO
Name	:	MS. TAMARA LAMP-WATSON
Credential	:
Telephone Number	:	513-821-9890

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	08/22/2020

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