Healthcare Provider Details

I. General information

NPI: 1982541074
Provider Name (Legal Business Name): SARAH WILLE ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 CROSS ST
MIDDLETOWN CT
06459-3213
US

IV. Provider business mailing address

26 LAKEVIEW RD
SPARTA NJ
07871-2245
US

V. Phone/Fax

Practice location:
  • Phone: 860-685-3528
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2005
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: