MARY PENKO BALES Occupational Therapist License verification

Business Entity

NOT RENEWED

License Type

Occupational Therapist

Description

OCCUPATIONAL THERAPIST

License Number

056007235

License Status

NOT RENEWED

Business

First Name

MARY

Middle

PENKO

Last Name

BALES

Business Name

MARY PENKO BALES

Original Issue Date

07/13/2004

Effective Date

11/24/2009

Expiration Date

12/31/2011

City

ROCKFORD

State

Zip

61114

County

WINNEBAGO

Ever Disciplined

LastModifiedDate

02/08/2012