Healthcare Provider Details

I. General information

NPI: 1477856243
Provider Name (Legal Business Name): THERESA WIEGAND-SWIHART M.S.,OTR/CHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2010
Last Update Date: 07/02/2024
Certification Date: 07/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

639 S WALKER ST STE A
BLOOMINGTON IN
47403-2124
US

IV. Provider business mailing address

4690 N BENTON DR
BLOOMINGTON IN
47408-9502
US

V. Phone/Fax

Practice location:
  • Phone: 317-455-1064
  • Fax:
Mailing address:
  • Phone: 812-320-1244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number31002009A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: