Tara Banks Feddern, OTR/L

Primary specialty

Pediatric Occupational TherapistTaxonomy code 225XP0200X

License

OT006793 Issued in GA

Practice address

4319 South Lee Street Suite 300
Chandler Speech and Language Services, LLC
Buford, GA 30518

Phone

(678) 288-9770

Fax

(678) 288-9774

NPI assigned

Jul 26, 2017

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Tara Banks Malone Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• Wonder Therapeutic Services LLC

  • Occupational Therapist
  • Flowery Branch, GA
  • NPI 1356067219
  NPD Authorized official

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

{
    "created_epoch": "1501027200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1520812800000",
    "number": "1639693278",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6477 MOSSY BOULDER DR",
            "address_2": "WONDER THERAPEUTIC SERVICES, LLC",
            "city": "FLOWERY BRANCH",
            "state": "GA",
            "postal_code": "30542",
            "telephone_number": "404-406-8272"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4319 SOUTH LEE STREET SUITE 300",
            "address_2": "CHANDLER SPEECH AND LANGUAGE SERVICES, LLC",
            "city": "BUFORD",
            "state": "GA",
            "postal_code": "30518",
            "telephone_number": "678-288-9770",
            "fax_number": "678-288-9774"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FEDDERN",
        "first_name": "TARA",
        "middle_name": "BANKS",
        "name_prefix": "Mrs.",
        "credential": "OTR/L",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-07-26",
        "last_updated": "2018-03-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225XP0200X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Pediatrics",
            "state": "GA",
            "license": "OT006793",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003194815A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TARA",
            "last_name": "MALONE",
            "middle_name": "BANKS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Zachary George Farley, D.P.M.
• Erin Farmer
• Kehinde Fasoranti, R.PH
• Fast Care Clinic Corporation
• Alexandria Lynn Faust
• Toni Feite, OTD, OTR/L
• Brian Daniel Feldman, LPC, NCC, CCMHC
• Amber Paige Ferguson, FNP-C
• Melissa Ferris-Ozkan
• Katharine Janelle Field Lewis, BCBA

• Pediatric Occupational Therapist in Buford, GA
• Providers in Buford, 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 12, 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.