TERRY J SUPAN Orthotist, Prosthetist, and Pedorthist License verification

Business Entity

INACTIVE

License Type

Orthotist, Prosthetist, and Pedorthist

Description

LICENSED ORTHOTIST

License Number

213000001

License Status

INACTIVE

Business

First Name

TERRY

Middle

Last Name

SUPAN

Business Name

TERRY J SUPAN

Original Issue Date

11/16/2001

Effective Date

09/30/2019

Expiration Date

12/31/2021

City

ROCHESTER

State

Zip

62563

County

SANGAMON

Ever Disciplined

LastModifiedDate

12/02/2021