Colleen Koontz

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

056004413 Issued in IL

Practice address

860 Center CT
Shorewood, IL 60404-8534

Phone

(815) 773-9000

Fax

(815) 773-9001

NPI assigned

Aug 23, 2025

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Ms. Colleen Petak Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1755907200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1755907200000",
    "number": "1093693566",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "518 SIERRA ROSE CIR",
            "city": "JOLIET",
            "state": "IL",
            "postal_code": "604314909",
            "telephone_number": "815-351-2522"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "860 CENTER CT",
            "city": "SHOREWOOD",
            "state": "IL",
            "postal_code": "604048534",
            "telephone_number": "815-773-9000",
            "fax_number": "815-773-9001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOONTZ",
        "first_name": "COLLEEN",
        "name_prefix": "Mrs.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-08-23",
        "last_updated": "2025-08-23",
        "certification_date": "2025-08-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "IL",
            "license": "056004413",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "COLLEEN",
            "last_name": "PETAK",
            "prefix": "MS.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Barbara Kellogg, COTA/L
• Janet Kendall, RPH
• Traci Lynne Keyster, FNP
• Matthew Reiot Klebenow, O.T.
• Kelsey Margaret Knarr, MA. CFY-SLP
• Samantha Kothapalli, DMD
• Briana Nicole Kregas, OTR/L
• April D Kubinski, MSN FPA-APRN
• Kuhar Vision Care PC
• Ludwig Chad Kuhar, O.D.

• Occupational Therapist in Shorewood, IL
• Providers in Shorewood, IL by specialty
• Occupational Therapist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.