Individual
HEATHER KODER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
USS TRANQUILITY 3410 ILLINOIS ST, GREAT LAKES, IL 60088
(224) 392-6914
Mailing address
3852 N PONTIAC AVE, CHICAGO, IL 60634-1929
Taxonomy
Speciality
Code
Description
License number
State
246Z00000X
Other Specialist/Technologist
Primary
160.009101
IL
Other
Enumeration date
03/24/2025
Last updated
03/24/2025
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