=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265306732
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SAGUARO SPROUTS PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/30/2025
-----------------------------------------------------
Last Update Date | 09/30/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2549 N FAIR OAKS AVE
-----------------------------------------------------
City | TUCSON
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85712-2406
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 520-477-1838
-----------------------------------------------------
Fax | 520-482-0351
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11240 E VAIL VISTA CT
-----------------------------------------------------
City | TUCSON
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85747-6270
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 520-477-1838
-----------------------------------------------------
Fax | 520-482-0351
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OCCUPATIONAL THERAPIST
-----------------------------------------------------
Name | LESLIE LAMB
-----------------------------------------------------
Credential | OTD
-----------------------------------------------------
Telephone | 520-477-1838
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------