West Virginia
Board of Respiratory Care
Practitioner Account
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- NEW LICENSE REQUEST
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Password:
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Question:
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Answer:
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Last Name:
*
First Name:
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SSN:
Work Phone:
Home/Cell Phone:
Birthday:
*
Address:
*
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Do not share name and address with organizations which may offer continuing education or employment opportunities:
Highest Degree:
Associate
Bachelors
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Other
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From:
Graduated On:
What year did you pass the NBRC exam?
What year does your NBRC exam expire?
Employer:
*
Address:
*
City:
State:
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
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Iowa
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Maryland
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Micronesia
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Northern Marianas
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Palau
Pennsylvania
Puerto Rico
Rhode Island
Sourth Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Type of Practice:
* Missing *
Healthcare Facility
Home Care
Telehealth
Sleep Lab
PFT Lab
BoRC License #:
*
Type:
Associate
Certified
Expired
Registered
Student
Temp Certified
Temp Registered
Temp Student
*
Initial License Date:
Inactive?
as of
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License History
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