Provider Demographics
NPI:1588146674
Name:SICKLER, MARCUS ANTHONY (MOT OTR/L)
Entity type:Individual
Prefix:
First Name:MARCUS
Middle Name:ANTHONY
Last Name:SICKLER
Suffix:
Gender:M
Credentials:MOT OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4643 36TH AVE S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-5180
Mailing Address - Country:US
Mailing Address - Phone:701-260-2005
Mailing Address - Fax:
Practice Address - Street 1:2800 MAIN AVE
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-6811
Practice Address - Country:US
Practice Address - Phone:701-365-8868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-05
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1668225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty