MARIA ANNE PROVANCAL Occupational Therapist License verification

Business Entity

ACTIVE

License Type

Occupational Therapist

Description

OCCUPATIONAL THERAPIST

License Number

056012310

License Status

ACTIVE

Business

First Name

MARIA

Middle

ANNE

Last Name

PROVANCAL

Business Name

MARIA ANNE PROVANCAL

Original Issue Date

12/21/2017

Effective Date

10/07/2025

Expiration Date

12/31/2027

City

VILLA PARK

State

Zip

60181

County

DUPAGE

Ever Disciplined

LastModifiedDate

10/07/2025