Individual
MRS. TARA BANKS FEDDERN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
4319 SOUTH LEE STREET SUITE 300, CHANDLER SPEECH AND LANGUAGE SERVICES, LLC, BUFORD, GA 30518
(678) 288-9770
(678) 288-9774
Mailing address
6477 MOSSY BOULDER DR, WONDER THERAPEUTIC SERVICES, LLC, FLOWERY BRANCH, GA 30542
(404) 406-8272
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
OT006793
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003194815A
—
GA
Enumeration date
07/26/2017
Last updated
03/12/2018
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