MIRIAM DAWN ROTH Occupational Therapist License verification

Business Entity

INACTIVE

License Type

Occupational Therapist

Description

OCCUPATIONAL THERAPIST

License Number

056005849

License Status

INACTIVE

Business

First Name

MIRIAM

Middle

DAWN

Last Name

ROTH

Business Name

MIRIAM DAWN ROTH

Original Issue Date

07/12/2000

Effective Date

01/06/2004

Expiration Date

12/31/2005

City

METAMORA

State

Zip

61548

County

WOODFORD

Ever Disciplined

LastModifiedDate

10/25/2005