Active NPI
Sandra Dee Jackson
- Occupational Therapist
- Rogers, AR
National Provider Identifier
1033056767
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- OTR4055
- Practice address
- 5522 W Northgate Rd
Rogers, AR 72758-2017 - Phone
- (479) 622-8183
- NPI assigned
- Apr 30, 2026
- Sex
- Female
- Sole proprietor
- Yes
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 | OTR4055 | AR | Primary |
Addresses
Primary practice location
5522 W Northgate Rd
Rogers, AR 72758-2017
Mailing address
22 Allendale Dr
Bella Vista, AR 72714-5218
Phone (479) 622-8183
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in AR
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20260521001498 | AR | Practitioner - Occupational Therapist in Private Practice | 7911476791 | Reassigns benefits to 1 organization |
Care Compare profile
Medicare Care Compare- Specialty
- Occupational Therapist in Private Practice
- Education
- Other, 1994
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
650 S Dodson Rd
Rogers, AR 72758-7015
Phone (479) 250-9832
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OTR4055 | AR | MD | Occupational Therapist |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1777507200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1777507200000",
"number": "1033056767",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "22 ALLENDALE DR",
"city": "BELLA VISTA",
"state": "AR",
"postal_code": "727145218",
"telephone_number": "479-622-8183"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5522 W NORTHGATE RD",
"city": "ROGERS",
"state": "AR",
"postal_code": "727582017",
"telephone_number": "479-622-8183"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "SANDRA",
"middle_name": "DEE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2026-04-30",
"last_updated": "2026-04-30",
"certification_date": "2026-04-30",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Occupational Therapist",
"state": "AR",
"license": "OTR4055",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rogers, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.