Regulated ProfessionsOccupational TherapistsChange of Address Please provide the Missouri Board of Occupational Therapy with any change in your home address. Please use the form below to report address changes, and click submit. You must complete the form in its entirety or no changes will be made. Name as it appears on the certificate Last Name: First Name: Middle Initial: LRegistration: Email: New Address Street: City: State: Zip Code: Telephone Number: Previous Address Street: City: State: Zip Code: Telephone Number: