West Virginia
Board of Respiratory Care
Practitioner Account
    

Practitioner Information - NEW LICENSE REQUEST

User Name: * <-- This must be a valid email address.
Password: * 
Question: <-- You will be prompted with this when changing your password.
Answer: <-- This must be your response when asked the above question.
 
Last Name: * First Name: *  SSN: 
Work Phone: Home/Cell Phone: Birthday:  *
Address: *    County:  *
City: *    State:  *    ZIP:  *   
 
Highest Degree: *  From:    Graduated On:   
What year did you pass the NBRC exam?      What year does your NBRC exam expire?     
Employer: *
Address: * City: State:
Type of Practice: 
 
BoRC License #: *  Type: *  Initial License Date:  as of
Attach a file:   
         

License History


Continuing Education


Disciplinary Actions