MACIE KATHRYN ZACK (MS, OTRL) – Occupational Therapist, NPI 1104663723

MACIE KATHRYN ZACK (MS, OTRL) is a healthcare provider. based in Grand rapids, Michigan. specializing in OCCUPATIONAL THERAPIST IN PRIVATE PRACTICE. They hold the professional credentials MS, OTRL. They hold a License No. 5201013663 (MI). The NPI Number for MACIE KATHRYN ZACK (MS, OTRL) is 1104663723

Main info

Female
Sole Proprietor
3 Years Of Experience
Accepts Medicare Assignment
Name
MACIE KATHRYN ZACK (MS, OTRL)
NPI
1104663723
Phone
(616) 267-9200
Address
4100 Lake Dr SE Ste 305
Enumeration Date
11 July 2024
Last Update Date
11 July 2024

Doctor Profile

Medical School Name
OTHER
Secondary Phone
3608994905
Graduation Year
2023 (3 years ago)
PAC ID
5597203109
Group Practice PAC ID
0547515652
Professional Enrollment ID
I20240814002298
Address ID
WA982733440MO111XXSTXX400
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience35
Completeness75
Years active:1State licenses:2Digital endpointsOther names

711 OCCUPATIONAL THERAPIST IN PRIVATE PRACTICE in MI

Provider Addresses for MACIE KATHRYN ZACK (MS, OTRL)

  • 4100 Lake Dr SE Ste 305

    Grand Rapids, MI 495468292

    Phone: (616) 267-9200

    Type: Location

  • 2900 GRAND AVE APT 642

    EVERETT, WA 982014898

    Phone: (616) 430-1651

    Type: Mailing

  • 1101 E DIVISION ST

    MOUNT VERNON, WA 982744004

    Phone: (360) 899-4905

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2024-08-14

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20240814002298IOccupational Therapist In Private PracticeWATBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 49546)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 0547515652View full group profile
NameSpecialtyState
Occupational Therapist In Private PracticeWA
Occupational Therapist In Private PracticeTN
Occupational Therapist In Private PracticeWA
-WA
Occupational Therapist In Private PracticeWA
Occupational Therapist In Private PracticeWA
Occupational Therapist In Private PracticeFL
Occupational Therapist In Private PracticeTX

Reviews

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Frequently asked questions

What is the registry number for MACIE KATHRYN ZACK (MS, OTRL)?
The registry entry for MACIE KATHRYN ZACK (MS, OTRL) shows NPI 1104663723.
Is MACIE KATHRYN ZACK (MS, OTRL) currently accepting referrals based on NPI status?
Registry metadata lists MACIE KATHRYN ZACK (MS, OTRL) as active.
What does the directory say MACIE KATHRYN ZACK (MS, OTRL) does?
Insurance directories may phrase it differently, but here MACIE KATHRYN ZACK (MS, OTRL) maps to Occupational Therapist. Clinical services aligned with this taxonomy classification.
Which community is linked to MACIE KATHRYN ZACK (MS, OTRL)?
MACIE KATHRYN ZACK (MS, OTRL) shows a connection to Grand Rapids, Michigan in registry-derived data.
Can I export MACIE KATHRYN ZACK (MS, OTRL)'s record?
You can download the official NPPES record; we summarize key fields for readability.

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