Provider Demographics
NPI:1760196943
Name:BOENING, TYLER (OTR/L)
Entity Type:Individual
Prefix:MISS
First Name:TYLER
Middle Name:
Last Name:BOENING
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MRS
Other - First Name:TYLER
Other - Middle Name:
Other - Last Name:READE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR/L
Mailing Address - Street 1:12 ARGYLE PL
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-6101
Mailing Address - Country:US
Mailing Address - Phone:516-603-6400
Mailing Address - Fax:
Practice Address - Street 1:12 ARGYLE PL
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-6101
Practice Address - Country:US
Practice Address - Phone:516-603-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-11
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027640225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist