DIANA LEIA LONGWELL Occupational Therapist License verification

Business Entity

NOT RENEWED

License Type

Occupational Therapist

Description

OCCUPATIONAL THERAPIST

License Number

056009018

License Status

NOT RENEWED

Business

First Name

DIANA

Middle

LEIA

Last Name

LONGWELL

Business Name

DIANA LEIA LONGWELL

Original Issue Date

04/16/2010

Effective Date

04/16/2010

Expiration Date

12/31/2011

City

SPRINGFIELD

State

Zip

62704

County

SANGAMON

Ever Disciplined

LastModifiedDate

02/08/2012