SHAENA K DIETZ Occupational Therapist License verification

Business Entity

INACTIVE

License Type

Occupational Therapist

Description

OCCUPATIONAL THERAPIST

License Number

056004757

License Status

INACTIVE

Business

First Name

SHAENA K

Last Name

DIETZ

Business Name

SHAENA K DIETZ

Original Issue Date

02/25/1998

Effective Date

02/05/2004

Expiration Date

12/31/2003

City

MAPLE PARK

State

Zip

60151

County

DEKALB

Ever Disciplined

LastModifiedDate

09/11/2005