# EASTERSEALS NORTHEAST CENTRAL FLORIDA, INC.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** \#MIP
- **Organization subpart:** No

## Provider details

- **NPI number:** 1073387387
- **Authorized official:** MICHELE WALLENS (ACCOUNTING MANAGER)
- **Authorized official phone:** (386) 255-4568

## Contact information

- **Practice address:** 3389 N STATE ST UNIT 1, BUNNELL, FL 32110-4340
- **Practice address phone:** (386) 255-4568
- **Practice address fax:** (386) 258-7677
- **Mailing address:** 1219 DUNN AVE, DAYTONA BEACH, FL 32114-2405
- **Mailing address phone:** (386) 944-7805
- **Mailing address fax:** (386) 258-7677

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | — | NULL | — |
| 225100000X | Physical Therapist | — | — | — |
| 225X00000X | Occupational Therapist | — | NULL | — |
| 225X00000X | Occupational Therapist | — | — | — |
| 235Z00000X | Speech-Language Pathologist | — | NULL | — |
| 235Z00000X | Speech-Language Pathologist | — | — | — |
| 261QM1300X | Multi-Specialty Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 11/08/2023
- **Last updated:** 11/08/2023