Healthcare Provider Details

I. General information

NPI: 1568648848
Provider Name (Legal Business Name): SARAH IMELDA SANDOVAL OTR/L, MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2008
Last Update Date: 10/31/2025
Certification Date: 10/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14145 N 92ND ST UNIT 2100
SCOTTSDALE AZ
85260-3717
US

IV. Provider business mailing address

17104 PIERCE ST
OMAHA NE
68130-1027
US

V. Phone/Fax

Practice location:
  • Phone: 402-321-6881
  • Fax:
Mailing address:
  • Phone: 402-321-6881
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT 8090
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number19177
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: