HAZEL NALYN C BASA Occupational Therapist License verification

Business Entity

INACTIVE

License Type

Occupational Therapist

Description

OCCUPATIONAL THERAPY ASSISTANT

License Number

057004759

License Status

INACTIVE

Business

First Name

HAZEL NALYN

Middle

Last Name

BASA

Business Name

HAZEL NALYN C BASA

Original Issue Date

05/30/2017

Effective Date

12/04/2019

Expiration Date

12/31/2021

City

PLAINFIELD

State

Zip

60544

County

WILL

Ever Disciplined

LastModifiedDate

11/17/2021