DIANE M JELLEMA - Occupational Therapist License in Indiana | # 057000366

DIANE M JELLEMA

Business Entity

NOT RENEWED

License Type

Occupational Therapist

Description

OCCUPATIONAL THERAPY ASSISTANT

License Number

057000366

License Status

NOT RENEWED

Business

N

First Name

DIANE

Middle

M

Last Name

JELLEMA

Business Name

DIANE M JELLEMA

Original Issue Date

02/27/1986

Effective Date

12/12/2019

Expiration Date

01/31/2022

State

IN

Ever Disciplined

N

LastModifiedDate

05/18/2022