Healthcare Provider Details

I. General information

NPI: 1760766869
Provider Name (Legal Business Name): SPROUTS THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2011
Last Update Date: 08/06/2025
Certification Date: 08/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94-1181 KA UKA BLVD STE C
WAIPAHU HI
96797-4485
US

IV. Provider business mailing address

94-1181 KA UKA BLVD STE C
WAIPAHU HI
96797-4485
US

V. Phone/Fax

Practice location:
  • Phone: 808-260-9056
  • Fax: 877-518-7858
Mailing address:
  • Phone: 808-260-9056
  • Fax: 877-518-7858

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: CRYSTAL LYNN AMELANG
Title or Position: OWNER
Credential: OTR/L
Phone: 858-248-7824