BRADLEY KEITH AUGUSTSON Athletic Trainer License verification

Business Entity

NOT RENEWED

License Type

Athletic Trainer

Description

LICENSED ATHLETIC TRAINER

License Number

096001766

License Status

NOT RENEWED

Business

First Name

BRADLEY

Middle

KEITH

Last Name

AUGUSTSON

Business Name

BRADLEY KEITH AUGUSTSON

Original Issue Date

03/24/2003

Effective Date

06/16/2004

Expiration Date

05/31/2004

City

LAKE GENEVA

State

Zip

53147

County

WISCONSIN

Ever Disciplined

LastModifiedDate

09/11/2005