MEDICARE: EASTER SEALS MISSOURI, INC

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	251C00000X	Developmentally Disabled Services Day Training Agency

General Provider Information

NPI Number	:	1609918903
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EASTER SEALS MISSOURI, INC

Provider Business Mailing Address
First Line	:	13975 MANCHESTER RD
Second Line	:
City	:	BALLWIN
State	:	MO
Zip	:	63011-4500
Country	:	US
Telephone Number	:	636-779-2250
Fax Number	:	636-779-2270

Provider Business Practice Location Address
First Line	:	13975 MANCHESTER RD
Second Line	:
City	:	BALLWIN
State	:	MO
Zip	:	63011-4500
Country	:	US
Telephone Number	:	636-779-2250
Fax Number	:	636-779-2270

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. CRAIG BYRD
Credential	:
Telephone Number	:	636-779-2250

Provider Enumeration Date	:	02/13/2007
Last Update Date	:	08/22/2020

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