SAMANTHA KRISTINE VAN DER WEIDE Occupational Therapist License verification

Business Entity

ACTIVE

License Type

Occupational Therapist

Description

OCCUPATIONAL THERAPY ASSISTANT

License Number

057004866

License Status

ACTIVE

Business

First Name

SAMANTHA

Middle

KRISTINE

Last Name

VAN DER WEIDE

Business Name

SAMANTHA KRISTINE VAN DER WEIDE

Original Issue Date

12/07/2017

Effective Date

12/10/2025

Expiration Date

12/31/2027

City

LATHAM

State

Zip

62543

County

LOGAN

Ever Disciplined

LastModifiedDate

12/10/2025