Individual
FREDERICA KENNEDY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR/L, OTD
Contact information
Practice address
2095 HIGHWAY 211 NW STE D, BRASELTON, GA 30517-3402
(770) 207-6390
(678) 374-4855
Mailing address
2791 SUMMIT VALLEY DRIVE, DACULA, GA 30019
(708) 612-2881
(708) 283-8685
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
—
—
225X00000X
Occupational Therapist
056.006013
IL
225XP0200X
Pediatric Occupational Therapist
Primary
OT006737
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003200220A
—
GA
05
—
003200220B
—
GA
Enumeration date
05/07/2007
Last updated
03/17/2018
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