STACI L GOMEZ Occupational Therapist License verification

Business Entity

INACTIVE

License Type

Occupational Therapist

Description

OCCUPATIONAL THERAPIST

License Number

056002705

License Status

INACTIVE

Business

First Name

STACI L

Last Name

GOMEZ

Business Name

STACI L GOMEZ

Original Issue Date

09/11/1991

Effective Date

01/26/2004

Expiration Date

12/31/2003

City

BURLINGTON

State

Zip

53105

County

WISCONSIN

Ever Disciplined

LastModifiedDate

07/30/2025