ANTIGONE DAWN BLACKWELL Occupational Therapist License verification

Business Entity

NOT RENEWED

License Type

Occupational Therapist

Description

OCCUPATIONAL THERAPIST

License Number

056005060

License Status

NOT RENEWED

Business

First Name

ANTIGONE

Middle

DAWN

Last Name

BLACKWELL

Business Name

ANTIGONE DAWN BLACKWELL

Original Issue Date

11/10/1998

Effective Date

05/18/2000

Expiration Date

12/31/1999

City

URBANA

State

Zip

61801

County

CHAMPAIGN

Ever Disciplined

LastModifiedDate

07/28/2005