Healthcare Provider Details

I. General information

NPI: 1427169325
Provider Name (Legal Business Name): THERAPEUTIC LEARNING CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 CHAPMAN ST SUITE 104
CANTON MA
02021-2093
US

IV. Provider business mailing address

500 CHAPMAN ST SUITE 104
CANTON MA
02021-2093
US

V. Phone/Fax

Practice location:
  • Phone: 781-821-9955
  • Fax: 781-821-9950
Mailing address:
  • Phone: 781-821-9955
  • Fax: 781-821-9950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5425
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number237
License Number StateMA

VIII. Authorized Official

Name: MS. DIANE L MAXSON
Title or Position: PRESIDENT
Credential: OTR
Phone: 781-821-9955