Change of Address

Please provide the Missouri Board of Occupational Therapy with any change in your home address, phone #'s or email address. Please use the form below to report changes and click submit.

To change only your phone #'s or email address, please click on the changed information.

Name as it appears on the certificate
Last Name:
First Name:
Middle Initial:
License #:

Current Address
Current Street:
Current City:
Current State:
Current Zip Code:
Current Telephone Number:
Current Email: