The holder whose full name is Southivong, Brooke,come from Fort Wayne IN,hold the Occ Therapy Assistant license(NO.32002424A) which status is Active.
| Name | Southivong, Brooke |
|---|---|
| License Number | 32002424A |
| License Type | Occ Therapy Assistant |
| License Status | Active |
| City | Fort Wayne |
| State | IN |