Healthcare Provider Details

I. General information

NPI: 1902714652
Provider Name (Legal Business Name): TANYA WILE WASSERBOEHR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7A CYPRESS DR
BURLINGTON MA
01803-4907
US

IV. Provider business mailing address

6 SARAFINA WAY
WILMINGTON MA
01887-4554
US

V. Phone/Fax

Practice location:
  • Phone: 781-328-0951
  • Fax:
Mailing address:
  • Phone:
  • Fax: 978-408-9662

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: