Provider Demographics
NPI:1568648848
Name:SANDOVAL, SARAH IMELDA (OTR/L, MA)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:IMELDA
Last Name:SANDOVAL
Suffix:
Gender:F
Credentials:OTR/L, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17104 PIERCE ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68130-1027
Mailing Address - Country:US
Mailing Address - Phone:402-321-6881
Mailing Address - Fax:
Practice Address - Street 1:17104 PIERCE ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68130-1027
Practice Address - Country:US
Practice Address - Phone:402-321-6881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-16
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT 8090225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist