Healthcare Provider Details

I. General information

NPI: 1255672226
Provider Name (Legal Business Name): TERESA PAJOR OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TERESA NYDEGGER OT

II. Dates (important events)

Enumeration Date: 03/15/2013
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1733 N RICHMOND RD
MCHENRY IL
60051-5413
US

IV. Provider business mailing address

2122 YORK RD STE 300
OAK BROOK IL
60523-1925
US

V. Phone/Fax

Practice location:
  • Phone: 815-385-0730
  • Fax: 815-385-0572
Mailing address:
  • Phone: 630-575-6200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number056010181
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: