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Name License No. NORTH DAKOTA STATE BOARD OF OCCUPATIONAL THERAPY PRACTICE ADMINISTRATIVE RULES SELF ASSESSMENT This must be completed and submitted with the license renewal application and renewal

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Start by writing your full legal name in the designated space.

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Next, enter your license number, which can typically be found on your driver's license or identification card.

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Finally, include the word "north" to specify that the license is issued in the northern region.

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Individuals who reside or conduct business in the northern region.

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Anyone who needs to verify their identity or qualifications in the northern region.

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