Heather Koder, PTA

Primary specialty

Other Specialist/TechnologistTaxonomy code 246Z00000X

License

160.009101 Issued in IL

Practice address

Uss Tranquility 3410 Illinois St
Great Lakes, IL 60088

Phone

(224) 392-6914

NPI assigned

Mar 24, 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

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": "1742774400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1742774400000",
    "number": "1285435172",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3852 N PONTIAC AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606341929"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "USS TRANQUILITY 3410 ILLINOIS ST",
            "city": "GREAT LAKES",
            "state": "IL",
            "postal_code": "60088",
            "telephone_number": "224-392-6914"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KODER",
        "first_name": "HEATHER",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-03-24",
        "last_updated": "2025-03-24",
        "certification_date": "2025-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "246Z00000X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Other",
            "state": "IL",
            "license": "160.009101",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dorothy C Kent, MSN,PNP
• Jason Yungsup Kim, MD
• Min Kwan Kim, M.D.
• Bonnie J. Kimoto, R.D.
• Michelle Ann Klupp, RDH
• Seth David Koerner, RPH
• Claire Kubiesa, PH.D.
• Glenn A Kurtz, DDS
• Kelly Robert Lanning, DMD
• Clinton Lariscy, IDC

• Other Specialist/Technologist in Great Lakes, IL
• Providers in Great Lakes, IL by specialty
• Other Specialist/Technologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 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.