KELLY ANN ROTH Orthotist, Prosthetist, and Pedorthist License verification

Business Entity

NOT RENEWED

License Type

Orthotist, Prosthetist, and Pedorthist

Description

LICENSED PROSTHETIST

License Number

211000319

License Status

NOT RENEWED

Business

First Name

KELLY

Middle

ANN

Last Name

ROTH

Business Name

KELLY ANN ROTH

Original Issue Date

12/07/2016

Effective Date

11/18/2021

Expiration Date

09/30/2023

City

CROWN POINT

State

Zip

46307

County

LAKE

Ever Disciplined

LastModifiedDate

02/02/2024