The holder whose full name is Smith, Amanda Nichole,come from Fort Wayne IN,hold the Temporary Occ Therapist Permit license(NO.99053069A) which status is Superceded.
| Name | Smith, Amanda Nichole |
|---|---|
| License Number | 99053069A |
| License Type | Temporary Occ Therapist Permit |
| License Status | Superceded |
| City | Fort Wayne |
| State | IN |