Mark David Provan
ExpiredCalifornia license 5495
License
- Licensed by
- California Board of Occupational Therapy
- License number
- 5495
- Status
- Expired (Delinquent)
- First issued
- January 3, 2003
- Expired
- September 30, 2023
- License holder
- Mark David Provan
- Entity type
- Individual
Classifications
- Occupational Therapist Therapy & Rehabilitation
More from the license record
- License type code
- 7101
Contact
4977 Refugio Rd
Santa Rosa, CA 95401-5542
Santa Rosa, CA 95401-5542
Sonoma County