NICOLE RENAE WIEGAND Occupational Therapist License verification

Business Entity

NOT RENEWED

License Type

Occupational Therapist

Description

OCCUPATIONAL THERAPY ASSISTANT

License Number

057002545

License Status

NOT RENEWED

Business

First Name

NICOLE

Middle

RENAE

Last Name

WIEGAND

Business Name

NICOLE RENAE WIEGAND

Original Issue Date

09/07/2004

Effective Date

11/07/2013

Expiration Date

12/31/2015

City

LEO

State

Zip

46765

County

INDIANA

Ever Disciplined

LastModifiedDate

02/08/2016