Healthcare Provider Details

I. General information

NPI: 1336061415
Provider Name (Legal Business Name): ELIZABETH M BERG BERG WIECZOREK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2170 STRUBLE RD
CINCINNATI OH
45231-1736
US

IV. Provider business mailing address

1323 SUNCREST DR
CINCINNATI OH
45208-2512
US

V. Phone/Fax

Practice location:
  • Phone: 513-742-6020
  • Fax:
Mailing address:
  • Phone: 406-601-9325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT010781
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: