HAZEL NALYN C BASA - Occupational Therapist License in Illinois | # 057004759

HAZEL NALYN C BASA

Business Entity

INACTIVE

License Type

Occupational Therapist

Description

OCCUPATIONAL THERAPY ASSISTANT

License Number

057004759

License Status

INACTIVE

Business

N

First Name

HAZEL NALYN

Middle

C

Last Name

BASA

Business Name

HAZEL NALYN C BASA

Original Issue Date

05/30/2017

Effective Date

12/04/2019

Expiration Date

12/31/2021

State

IL

Ever Disciplined

N

LastModifiedDate

11/17/2021