Active NPI
Kristen Canfield Bacon, OTD, MS, OTR/L
- Occupational Therapist
- Elmira, NY
National Provider Identifier
1174917561
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 015180-1
- Practice address
- 600 Roe Ave
Elmira, NY 14901 - Phone
- (607) 737-4100
- NPI assigned
- Mar 24, 2015
- 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 | 015180-1 | NY | Primary |
Addresses
Primary practice location
600 Roe Ave
Elmira, NY 14901
Mailing address
3494 County Road 28
Watkins Glen, NY 14891-9748
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
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 015180-1 | NY | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1427155200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1427155200000",
"number": "1174917561",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3494 COUNTY ROAD 28",
"city": "WATKINS GLEN",
"state": "NY",
"postal_code": "148919748"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "600 ROE AVE",
"city": "ELMIRA",
"state": "NY",
"postal_code": "14901",
"telephone_number": "607-737-4100"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BACON",
"first_name": "KRISTEN",
"middle_name": "CANFIELD",
"name_prefix": "Dr.",
"credential": "OTD, MS, OTR/L",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-03-24",
"last_updated": "2015-03-24",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "NY",
"license": "015180-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Elmira, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.