ASHLIE JILL WALLER Occupational Therapist License verification

Business Entity

NOT RENEWED

License Type

Occupational Therapist

Description

OCCUPATIONAL THERAPIST

License Number

056006004

License Status

NOT RENEWED

Business

First Name

ASHLIE

Middle

JILL

Last Name

WALLER

Business Name

ASHLIE JILL WALLER

Original Issue Date

11/21/2000

Effective Date

01/27/2004

Expiration Date

12/31/2003

City

CHAMPAIGN

State

Zip

61822

County

CHAMPAIGN

Ever Disciplined

LastModifiedDate

09/11/2005