MADISON E WALLACE Occupational Therapist License verification

Business Entity

ACTIVE

License Type

Occupational Therapist

Description

OCCUPATIONAL THERAPY ASSISTANT

License Number

057006121

License Status

ACTIVE

Business

First Name

MADISON

Middle

Last Name

WALLACE

Business Name

MADISON E WALLACE

Original Issue Date

05/15/2024

Effective Date

11/05/2025

Expiration Date

12/31/2027

City

ALTON

State

Zip

62002

County

MADISON

Ever Disciplined

LastModifiedDate

11/05/2025