TRACY D WALLACE Occupational Therapist License verification

Business Entity

NOT RENEWED

License Type

Occupational Therapist

Description

OCCUPATIONAL THERAPIST

License Number

056006191

License Status

NOT RENEWED

Business

First Name

TRACY

Middle

Last Name

WALLACE

Business Name

TRACY D WALLACE

Original Issue Date

05/25/2001

Effective Date

12/01/2003

Expiration Date

12/31/2005

City

ATHERTON

State

Zip

94027

County

CALIFORNIA

Ever Disciplined

LastModifiedDate

02/16/2006