Tara Ann Fedewa, OTR/L

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

5201013965 Issued in MI

Practice address

4660 S Hagadorn Rd Ste 400
East Lansing, MI 48823-5353

Phone

(517) 355-7648

Fax

(517) 432-1319

NPI assigned

Sep 8, 2020

Reactivated

Nov 8, 2024

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

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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.

• Msu Health Care Inc

  • Allergy & Immunology Physician
  • East Lansing, MI
  • NPI 1700418670
  Medicare reassignment NPD
• Msu Health Care Inc.

  • Physical Therapist
  • East Lansing, MI
  • NPI 1689206419

  Occupational Therapist

  NPD
• Msu Health Care Inc.

  • Diagnostic Radiology Physician
  • East Lansing, MI
  • NPI 1275165052
  NPD (past)

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

{
    "created_epoch": "1599523200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731369600000",
    "number": "1861006728",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "804 SERVICE RD STE A202",
            "city": "EAST LANSING",
            "state": "MI",
            "postal_code": "488247015",
            "telephone_number": "517-355-7648",
            "fax_number": "517-432-1319"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4660 S HAGADORN RD STE 400",
            "city": "EAST LANSING",
            "state": "MI",
            "postal_code": "488235353",
            "telephone_number": "517-355-7648",
            "fax_number": "517-432-1319"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FEDEWA",
        "first_name": "TARA",
        "middle_name": "ANN",
        "credential": "OTR/L",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-09-08",
        "last_updated": "2024-11-12",
        "certification_date": "2024-11-12",
        "deactivation_date": "2021-07-19",
        "reactivation_date": "2024-11-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "MI",
            "license": "5201013965",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nicholas Farrell
• Dynal Breeann Farrier, RBT
• Meghan Faust, LMSW, ACSW
• Sarah Elizabeth Fay-Simons, LMSW
• FBS Dental, PLLC
• Claire Wood Fedore, DDS
• Craig A. Fedore, D.D.S.
• Victoria Alyson Feeback, AUD
• Colleen Feeney
• Kimberly Feighner, OT

• Occupational Therapist in East Lansing, MI
• Providers in East Lansing, MI by specialty
• Occupational Therapist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.