Provider Demographics
NPI:1053737189
Name:SCHRAUFNAGEL, TYLEE (ATC)
Entity type:Individual
Prefix:
First Name:TYLEE
Middle Name:
Last Name:SCHRAUFNAGEL
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 RICH ST APT D
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02451-3687
Mailing Address - Country:US
Mailing Address - Phone:603-988-2502
Mailing Address - Fax:
Practice Address - Street 1:299 EVERETT AVE
Practice Address - Street 2:
Practice Address - City:CHELSEA
Practice Address - State:MA
Practice Address - Zip Code:02150-1547
Practice Address - Country:US
Practice Address - Phone:617-466-5060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA25662255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer