THERESE MARIE STALLER Occupational Therapist License verification

Business Entity

NOT RENEWED

License Type

Occupational Therapist

Description

OCCUPATIONAL THERAPY ASSISTANT

License Number

057003685

License Status

NOT RENEWED

Business

First Name

THERESE

Middle

MARIE

Last Name

STALLER

Business Name

THERESE MARIE STALLER

Original Issue Date

10/25/2012

Effective Date

10/25/2012

Expiration Date

12/31/2013

City

BELOIT

State

Zip

53511

County

WISCONSIN

Ever Disciplined

LastModifiedDate

02/19/2014