MEDICARE: SARA DANIELLE HOLEY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2255A2300X	Athletic Trainer	61327053	WA

General Provider Information

NPI Number	:	1902405079
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARA DANIELLE HOLEY

Provider Business Mailing Address
First Line	:	24048 SE 111TH ST
Second Line	:
City	:	ISSAQUAH
State	:	WA
Zip	:	98027-8320
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1819 N 135TH ST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98133-7799
Country	:	US
Telephone Number	:	360-393-9253
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/20/2020
Last Update Date	:	01/09/2026

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Directions to “ SARA DANIELLE HOLEY ” Practice Location

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