Frederica Kennedy, OTR/L, OTD

Primary specialty

Pediatric Occupational TherapistTaxonomy code 225XP0200X

License

OT006737 Issued in GA

Practice address

2095 Highway 211 NW Ste D
Braselton, GA 30517-3402

Phone

(770) 207-6390

Fax

(678) 374-4855

NPI assigned

May 7, 2007

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Activekidz & Adult Therapy Services

  • Physical Therapist
  • Loganville, GA
  • NPI 1881825057
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1178496000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1396958450",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2791 SUMMIT VALLEY DRIVE",
            "city": "DACULA",
            "state": "GA",
            "postal_code": "30019",
            "telephone_number": "708-612-2881",
            "fax_number": "708-283-8685"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2095 HIGHWAY 211 NW STE D",
            "city": "BRASELTON",
            "state": "GA",
            "postal_code": "305173402",
            "telephone_number": "770-207-6390",
            "fax_number": "678-374-4855"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1949 Highway 81 Ste 100",
            "address_purpose": "LOCATION",
            "city": "Loganville",
            "state": "GA",
            "postal_code": "300524583",
            "country_code": "US",
            "telephone_number": "770-207-6390",
            "fax_number": "678-374-4855",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KENNEDY",
        "first_name": "FREDERICA",
        "credential": "OTR/L, OTD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-05-07",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "222Q00000X",
            "taxonomy_group": "",
            "desc": "Developmental Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "IL",
            "license": "056.006013",
            "primary": false
        },
        {
            "code": "225XP0200X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Pediatrics",
            "state": "GA",
            "license": "OT006737",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003200220B",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003200220A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Joseph Henry Kanclerz, MSN, NP-C, RNFA
• Hannah Kanu
• Devendar Katkoori, M.D
• Kelly E Redwine LPC LLC
• Melissa Kaye Kemp, FNP-C
• Katherine Elaine Kessler
• Zainab Khan, MD
• Eun Hye Kim, RN
• Jennifer Lee King, FNP-BC
• Pavani Kolakalapudi, MD

• Pediatric Occupational Therapist in Braselton, GA
• Providers in Braselton, GA by specialty
• Pediatric Occupational Therapist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.