Active NPI
Colleen Marie Kennedy
- Occupational Therapist
- Peoria Heights, IL
National Provider Identifier
1194697292
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 056.016373
- Practice address
- 4450 N Prospect Rd Ste C5
Peoria Heights, IL 61616-6578 - Phone
- (309) 363-7594
- Fax
- (309) 966-3621
- NPI assigned
- Sep 19, 2025
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 056.016373 | IL | Primary |
Addresses
Primary practice location
4450 N Prospect Rd Ste C5
Peoria Heights, IL 61616-6578
Mailing address
1580 Burning Bush LN
Hoffman Estates, IL 60192-1207
Phone (309) 363-7594
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 056.016373 | IL | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1758240000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1758240000000",
"number": "1194697292",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1580 BURNING BUSH LN",
"city": "HOFFMAN ESTATES",
"state": "IL",
"postal_code": "601921207",
"telephone_number": "309-363-7594",
"fax_number": "309-966-3621"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4450 N PROSPECT RD STE C5",
"city": "PEORIA HEIGHTS",
"state": "IL",
"postal_code": "616166578",
"telephone_number": "309-363-7594",
"fax_number": "309-966-3621"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KENNEDY",
"first_name": "COLLEEN",
"middle_name": "MARIE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2025-09-19",
"last_updated": "2025-09-19",
"certification_date": "2025-09-19",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "IL",
"license": "056.016373",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Peoria Heights, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 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.