Provider Demographics
NPI:1366410383
Name:BASLER, KARI ELIZABETH (OT)
Entity type:Individual
Prefix:MRS
First Name:KARI
Middle Name:ELIZABETH
Last Name:BASLER
Suffix:
Gender:F
Credentials:OT
Other - Prefix:MRS
Other - First Name:KARI
Other - Middle Name:BASLER
Other - Last Name:WIESE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OT
Mailing Address - Street 1:3540 E 46TH ST
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-3403
Mailing Address - Country:US
Mailing Address - Phone:563-742-5900
Mailing Address - Fax:563-742-5980
Practice Address - Street 1:3540 E 46TH ST
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-3403
Practice Address - Country:US
Practice Address - Phone:563-742-5900
Practice Address - Fax:563-742-5980
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01529225X00000X
IL225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist