Provider Demographics
NPI:1790526226
Name:BACON, KELCEE ANN (OT)
Entity type:Individual
Prefix:
First Name:KELCEE
Middle Name:ANN
Last Name:BACON
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5757 W THUNDERBIRD RD STE E465
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306-4650
Mailing Address - Country:US
Mailing Address - Phone:602-843-9945
Mailing Address - Fax:602-843-8775
Practice Address - Street 1:5757 W THUNDERBIRD RD STE E465
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-4650
Practice Address - Country:US
Practice Address - Phone:602-843-9945
Practice Address - Fax:602-843-8775
Is Sole Proprietor?:No
Enumeration Date:2024-06-06
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist