Individual provider · Type 1 NPI
Heather Koder, PTA
Other Specialist/Technologist · Great Lakes, IL
NPI number
1285435172
Active
Practice location
Uss Tranquility 3410 Illinois St
Great Lakes, IL 60088
Mailing address
3852 N Pontiac Ave
Chicago, IL 60634-1929
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Other Specialist/Technologist Primary | 246Z00000X | 160.009101 (IL) |
Other Specialist/Technologist: General classification identifying individuals trained on specific equipment and technical procedures in one of a collection of miscellaneous healthcare disciplines.
Other other specialist/technologist providers in Great Lakes
About NPI 1285435172
Heather Koder, PTA's National Provider Identifier is 1285435172, issued on Mar 24, 2025. The primary taxonomy on file is Other Specialist/Technologist (246Z00000X), and the practice location is in Great Lakes, IL. The record was last updated on Mar 24, 2025.