License holder summary

Alyssa Rose Formyduval is a Occupational Therapist licensed to practice in Indiana. The address on file for Alyssa Rose Formyduval is Highland IN 46322. This licensed professional license is current. The license was granted 07/21/2014 and expired on 12/31/2014.

Indiana

Professional Licensing Agency

Alyssa Rose Formyduval
Occupational Therapist
License number
31005709A
Date granted
07/21/2014
Date expires
12/31/2014
Class
Occupational Therapist
Status
Active
Address
Highland IN 46322
indianalicensing.org
ID 29099804
LAST UPDATED 2024-03-31 14:54:38 UTC

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