TAMARA A DIETZEL Occupational Therapist License verification

Business Entity

NOT RENEWED

License Type

Occupational Therapist

Description

OCCUPATIONAL THERAPY ASSISTANT

License Number

057001158

License Status

NOT RENEWED

Business

First Name

TAMARA A

Last Name

DIETZEL

Business Name

TAMARA A DIETZEL

Original Issue Date

08/08/1995

Effective Date

01/27/2004

Expiration Date

12/31/2003

City

BURLINGTON

State

Zip

53105

County

WISCONSIN

Ever Disciplined

LastModifiedDate

09/11/2005