TERRY J SUPAN Orthotist, Prosthetist, and Pedorthist License verification

Business Entity

INACTIVE

License Type

Orthotist, Prosthetist, and Pedorthist

Description

LICENSED PEDORTHIST

License Number

212000003

License Status

INACTIVE

Business

First Name

TERRY

Middle

Last Name

SUPAN

Business Name

TERRY J SUPAN

Original Issue Date

12/07/2001

Effective Date

07/05/2007

Expiration Date

09/30/2009

City

ROCHESTER

State

Zip

62563

County

SANGAMON

Ever Disciplined

LastModifiedDate

07/09/2009