KELLY ANN BLACK Occupational Therapist License verification

Business Entity

NOT RENEWED

License Type

Occupational Therapist

Description

OCCUPATIONAL THERAPIST

License Number

056009759

License Status

NOT RENEWED

Business

First Name

KELLY

Middle

ANN

Last Name

BLACK

Business Name

KELLY ANN BLACK

Original Issue Date

05/18/2012

Effective Date

12/30/2019

Expiration Date

01/31/2022

City

FUQUAY VARINA

State

Zip

27526

County

NORTH CAROLINA

Ever Disciplined

LastModifiedDate

05/18/2022