Provider Demographics
NPI:1649737958
Name:BASLER, MARSHALL KIRK (ATC)
Entity Type:Individual
Prefix:
First Name:MARSHALL
Middle Name:KIRK
Last Name:BASLER
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 JOANNE LN
Mailing Address - Street 2:
Mailing Address - City:ROCHELLE
Mailing Address - State:IL
Mailing Address - Zip Code:61068-1301
Mailing Address - Country:US
Mailing Address - Phone:815-713-5981
Mailing Address - Fax:
Practice Address - Street 1:5328 MAIN ST STE 122
Practice Address - Street 2:
Practice Address - City:LISLE
Practice Address - State:IL
Practice Address - Zip Code:60532-4185
Practice Address - Country:US
Practice Address - Phone:630-324-8243
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-22
Last Update Date:2019-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0960045692255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer