Healthcare Provider Details

I. General information

NPI: 1043000292
Provider Name (Legal Business Name): MARGARET WIEDT OTD, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2025
Last Update Date: 05/22/2025
Certification Date: 05/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 S CALIFORNIA AVE
CHICAGO IL
60608-1858
US

IV. Provider business mailing address

3171 N ORCHARD ST APT 1
CHICAGO IL
60657-9769
US

V. Phone/Fax

Practice location:
  • Phone: 773-522-2010
  • Fax:
Mailing address:
  • Phone: 330-801-4273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XN1300X
TaxonomyNeurorehabilitation Occupational Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number056.016137
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: