STACEY SUSANNE BLEICK Occupational Therapist License verification

Business Entity

INACTIVE

License Type

Occupational Therapist

Description

OCCUPATIONAL THERAPIST

License Number

056005881

License Status

INACTIVE

Business

First Name

STACEY

Middle

SUSANNE

Last Name

BLEICK

Business Name

STACEY SUSANNE BLEICK

Original Issue Date

09/18/2000

Effective Date

12/01/2003

Expiration Date

12/31/2005

City

MENOMONEE FALLS

State

Zip

53051

County

LAKE

Ever Disciplined

LastModifiedDate

10/25/2005