License holder summary

Brooke Southivong is a Occupational Therapy Assistant licensed to practice in Indiana. The address on file for Brooke Southivong is Fort Wayne IN 46804. This licensed professional license is current. The license was granted 05/02/2013 and expired on 12/31/2014.

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

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