MARTHA LOUISE BLACK Occupational Therapist License verification

Business Entity

NOT RENEWED

License Type

Occupational Therapist

Description

OCCUPATIONAL THERAPIST

License Number

056005281

License Status

NOT RENEWED

Business

First Name

MARTHA

Middle

LOUISE

Last Name

BLACK

Business Name

MARTHA LOUISE BLACK

Original Issue Date

03/18/1999

Effective Date

05/18/2000

Expiration Date

12/31/1999

City

TERRE HAUTE

State

Zip

47803

County

INDIANA

Ever Disciplined

LastModifiedDate

07/28/2005