MARK WAYNE HAZEL Occupational Therapist License verification

Business Entity

NOT RENEWED

License Type

Occupational Therapist

Description

OCCUPATIONAL THERAPY ASSISTANT

License Number

057002521

License Status

NOT RENEWED

Business

First Name

MARK

Middle

WAYNE

Last Name

HAZEL

Business Name

MARK WAYNE HAZEL

Original Issue Date

07/06/2004

Effective Date

10/06/2017

Expiration Date

12/31/2019

City

TUNNEL HILL

State

Zip

62972

County

JOHNSON

Ever Disciplined

LastModifiedDate

03/05/2020