Last Updated: 4/21/2026 5:36:59 AM
Technician Detail| Name | TAMARA FORMAN |
| Type | Technician |
| Number | 12640 |
| City | JAY, OK 74346 |
| Status | CANCELED |
| Issue Date | 10/23/2008 |
| Renewed Date | 06/29/2009 |
| Expire Date | 07/31/2010 |
| End Date | 08/31/2010 |
|
Immunization? |
No |
Disciplinary
Action
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| Case Date | Case Number |
| No Disciplinary Action | |
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