BASIA CHANTE ZOYA WALLACE DOT Occupational Therapist License verification

Business Entity

ACTIVE

License Type

Occupational Therapist

Description

OCCUPATIONAL THERAPIST

License Number

056015836

License Status

ACTIVE

Business

Title

DOT

First Name

BASIA

Middle

CHANTE ZOYA

Last Name

WALLACE

Business Name

BASIA CHANTE ZOYA WALLACE DOT

Original Issue Date

12/15/2023

Effective Date

12/03/2025

Expiration Date

12/31/2027

City

ROUND LAKE

State

Zip

60073

County

LAKE

Ever Disciplined

LastModifiedDate

12/03/2025