Provider Demographics
NPI:1235245085
Name:FEDDERN-BEKCAN, TANYA (OT)
Entity Type:Individual
Prefix:MRS
First Name:TANYA
Middle Name:
Last Name:FEDDERN-BEKCAN
Suffix:
Gender:F
Credentials:OT
Other - Prefix:MS
Other - First Name:TANYA
Other - Middle Name:THERESA
Other - Last Name:FEDDERN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:5265 DATIL PEPPER RD
Mailing Address - Street 2:
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-5626
Mailing Address - Country:US
Mailing Address - Phone:305-785-5366
Mailing Address - Fax:
Practice Address - Street 1:3001 PALM COAST PKWY SE
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-8209
Practice Address - Country:US
Practice Address - Phone:386-446-6060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT 10409225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL8916101 00Medicaid