Provider Demographics
NPI:1477856243
Name:WIEGAND-SWIHART, THERESA (MS,OTR/CHT)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:
Last Name:WIEGAND-SWIHART
Suffix:
Gender:F
Credentials:MS,OTR/CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4690 N BENTON DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47408-9502
Mailing Address - Country:US
Mailing Address - Phone:812-320-1244
Mailing Address - Fax:
Practice Address - Street 1:639 S WALKER ST STE A
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47403-2124
Practice Address - Country:US
Practice Address - Phone:317-455-1064
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-16
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31002009A225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand