The holder whose full name is Banlasan, Joseph Tan,come from Lafayette IN,hold the Temporary Occ Therapist Permit license(NO.99018197A) which status is Superceded.
| Name | Banlasan, Joseph Tan |
|---|---|
| License Number | 99018197A |
| License Type | Temporary Occ Therapist Permit |
| License Status | Superceded |
| City | Lafayette |
| State | IN |