Organization
EASTERSEALS NORTHEAST CENTRAL FLORIDA, INC.
Active
Other names
#MIP
Organization subpart
No
Provider details
NPI number
Authorized official
MICHELE WALLENS (ACCOUNTING MANAGER)
(386) 255-4568
Entity
Organization
Contact information
Practice address
3389 N STATE ST UNIT 1, BUNNELL, FL 32110-4340
(386) 255-4568
(386) 258-7677
Mailing address
1219 DUNN AVE, DAYTONA BEACH, FL 32114-2405
(386) 944-7805
(386) 258-7677
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
—
—
225X00000X
Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
—
—
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Enumeration date
11/08/2023
Last updated
11/08/2023
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