Provider Demographics
NPI:1659600674
Name:O'CONNOR, TERESA (DEVELOPMENTAL THERAP)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:O'CONNOR
Suffix:
Gender:F
Credentials:DEVELOPMENTAL THERAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 HESSEL BLVD
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61820-6418
Mailing Address - Country:US
Mailing Address - Phone:217-398-5717
Mailing Address - Fax:
Practice Address - Street 1:410 HESSEL BLVD
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61820-6418
Practice Address - Country:US
Practice Address - Phone:217-398-5717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-22
Last Update Date:2009-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILTO16200606P222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist