Provider Demographics
NPI:1578973731
Name:LITTLE, WILLIAM WYATT (MA, LAT, ATC)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:WYATT
Last Name:LITTLE
Suffix:
Gender:M
Credentials:MA, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:159 WEAVER BLVD
Mailing Address - Street 2:
Mailing Address - City:WEAVERVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28787-8345
Mailing Address - Country:US
Mailing Address - Phone:828-658-0902
Mailing Address - Fax:
Practice Address - Street 1:890 CLARKS CHAPEL RD
Practice Address - Street 2:
Practice Address - City:WEAVERVILLE
Practice Address - State:NC
Practice Address - Zip Code:28787-8555
Practice Address - Country:US
Practice Address - Phone:828-658-0902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-28
Last Update Date:2020-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC19292255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1929OtherNORTH CAROLINA BOARD OF ATHLETIC TRAINER EXAMINERS (NCBATE)
2000006943OtherBOARD OF CERTIFICATION FOR THE ATHLETIC TRAINER (BOCATC)
AL1850OtherALABAMA BOARD OF ATHLETIC TRAINERS - LICENSE INACTIVE