Provider Demographics
NPI:1043501463
Name:CONSBRUCK, JANELL RUTH (OTR)
Entity type:Individual
Prefix:MRS
First Name:JANELL
Middle Name:RUTH
Last Name:CONSBRUCK
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:926 E E ST
Mailing Address - Street 2:PO BOX 2149
Mailing Address - City:HASTINGS
Mailing Address - State:NE
Mailing Address - Zip Code:68901-6617
Mailing Address - Country:US
Mailing Address - Phone:402-643-3181
Mailing Address - Fax:
Practice Address - Street 1:926 E E ST
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901-6617
Practice Address - Country:US
Practice Address - Phone:402-643-3181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-20
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1528225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist