Active NPI
Samantha Jacklyn Mahon, CTRS
- Recreation Therapist
- Traverse City, MI
National Provider Identifier
1255286795
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Recreation Therapist
- License
- 85003
- Practice address
- 610 Woodmere Ave
Traverse City, MI 49686-3103 - Phone
- (231) 735-3095
- NPI assigned
- Mar 2, 2026
- 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 |
|---|---|---|---|---|
| Recreation Therapist | 225800000X | 85003 | MI | Primary |
Addresses
Primary practice location
610 Woodmere Ave
Traverse City, MI 49686-3103
Mailing address
106 Ringneck LN
Buckley, MI 49620-9477
Phone (231) 735-3095
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 85003 | MI | MD | Recreation Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1772409600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1772409600000",
"number": "1255286795",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "106 RINGNECK LN",
"city": "BUCKLEY",
"state": "MI",
"postal_code": "496209477",
"telephone_number": "231-735-3095"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "610 WOODMERE AVE",
"city": "TRAVERSE CITY",
"state": "MI",
"postal_code": "496863103",
"telephone_number": "231-735-3095"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MAHON",
"first_name": "SAMANTHA",
"middle_name": "JACKLYN",
"credential": "CTRS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2026-03-02",
"last_updated": "2026-03-02",
"certification_date": "2026-03-01",
"status": "A"
},
"taxonomies": [
{
"code": "225800000X",
"taxonomy_group": "",
"desc": "Recreation Therapist",
"state": "MI",
"license": "85003",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Traverse City, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.