Spencer Jackson, OTR/L

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

5201013949 Issued in MI

Practice address

6333 Kalamazoo Ave SE Ste 600
Grand Rapids, MI 49508-7858

Phone

(616) 649-1577

Fax

(616) 710-3019

NPI assigned

Nov 23, 2021

Last updated

Oct 3, 2025By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Specialty

Occupational Therapist in Private Practice

Education

Other, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Mary Free Bed Rehabilitation HospitalGroup PAC ID 4587576541, 135 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: spencer.jackson.p4@direct.athleticoltd.nextgenshare.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Mary Free Bed Rehabilitation Hospital

  • Rehabilitation Hospital
  • Grand Rapids, MI
  • NPI 1730133463
  Medicare reassignment Care Compare group NPD
• Athletico LTD

  dba Athletico Physical Therapy

  • Physical Therapist
  • Oak Brook, IL
  • NPI 1821085028

  MI, Occupational Therapist

  Medicare reassignment NPD
• Mary Free Bed Rehabilitation Hospital

  dba Mary Free Bed Medical Group

  • Physical Medicine & Rehabilitation Physician
  • Grand Rapids, MI
  • NPI 1053641589
  NPD
• Athletico LTD

  dba Athletico Physical Therapy

  • Clinic/Center
  • Lafayette, IN
  • NPI 1053044867

  Occupational Therapist

  NPD
• Behavior Consultants, Inc

  • Behavior Analyst
  • Brighton, MI
  • NPI 1407196348
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1637625600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1759449600000",
    "number": "1184381337",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2122 YORK RD STE 300",
            "city": "OAK BROOK",
            "state": "IL",
            "postal_code": "605231925",
            "telephone_number": "630-575-6200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6333 KALAMAZOO AVE SE STE 600",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495087858",
            "telephone_number": "616-649-1577",
            "fax_number": "616-710-3019"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "SPENCER",
        "credential": "OTR/L",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-11-23",
        "last_updated": "2025-10-03",
        "certification_date": "2025-10-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "MI",
            "license": "5201013949",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michele Rae Anne Jackson, LMSW
• Michelle M Jackson
• Rhett Baylor Jackson, D.D.S
• Sarah Jackson
• Shadriq Jaleel Jackson, PHARM.D.
• Summer Jayne Jackson
• Tamara T Jackson
• Tegan Jackson
• Veronica Ann Jackson
• Whitney Denise Jackson

• Occupational Therapist in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Occupational Therapist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2025; 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.

Verify at the official NPI Registry.