Indiana
Professional Licensing Agency
Brooke Southivong
Occupational Therapy Assistant
License number
32002424A
Date granted
05/02/2013
Date expires
12/31/2014
Class
Occupational Therapy Assistant
Status
Active
Address
Fort Wayne IN 46804
indianalicensing.org
ID 8275678
LAST UPDATED 2024-04-19 03:31:53 UTC
LAST UPDATED 2024-04-19 03:31:53 UTC
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