Provider Demographics
NPI:1427169325
Name:THERAPEUTIC LEARNING CENTER, INC.
Entity type:Organization
Organization Name:THERAPEUTIC LEARNING CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:L
Authorized Official - Last Name:MAXSON
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:781-821-9955
Mailing Address - Street 1:500 CHAPMAN ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:CANTON
Mailing Address - State:MA
Mailing Address - Zip Code:02021-2093
Mailing Address - Country:US
Mailing Address - Phone:781-821-9955
Mailing Address - Fax:781-821-9950
Practice Address - Street 1:500 CHAPMAN ST
Practice Address - Street 2:SUITE 104
Practice Address - City:CANTON
Practice Address - State:MA
Practice Address - Zip Code:02021-2093
Practice Address - Country:US
Practice Address - Phone:781-821-9955
Practice Address - Fax:781-821-9950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5425225100000X
MA237225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Not Answered225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty