Provider Demographics
NPI:1609879477
Name:EASTER SEALS SOUTHWESTERN OHIO
Entity Type:Organization
Organization Name:EASTER SEALS SOUTHWESTERN OHIO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:
Authorized Official - Last Name:LAMP-WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-821-9890
Mailing Address - Street 1:231 CLARK RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45215-5539
Mailing Address - Country:US
Mailing Address - Phone:513-821-9890
Mailing Address - Fax:513-821-9895
Practice Address - Street 1:231 CLARK RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45215-5539
Practice Address - Country:US
Practice Address - Phone:513-821-9890
Practice Address - Fax:513-821-9895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0793799Medicaid