Individual
MRS. JILL ELIZABETH BACON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
5050 LINCOLN AVE, EVANSVILLE, IN 47715-7390
(812) 303-7245
Mailing address
5050 LINCOLN AVE, EVANSVILLE, IN 47715-7390
(812) 303-7245
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
31002687A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1518069913
LEGACY HEALTHCARE OUTPATIENT
IN
Enumeration date
11/27/2017
Last updated
06/16/2018
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