JACKIE NICHOLS CHAMBERLAIN Physical Therapist License verification

Business Entity

INACTIVE

License Type

Physical Therapist

Description

LICENSED PHYSICAL THERAPIST

License Number

070004903

License Status

INACTIVE

Business

First Name

JACKIE NICHOLS

Last Name

CHAMBERLAIN

Business Name

JACKIE NICHOLS CHAMBERLAIN

Original Issue Date

12/22/1986

Effective Date

09/30/2004

Expiration Date

09/30/2006

City

DECATUR

State

Zip

62526

County

MACON

Ever Disciplined

LastModifiedDate

07/13/2006