Provider Demographics
NPI:1467680199
Name:COMBALECER, VENUS REALES (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:VENUS
Middle Name:REALES
Last Name:COMBALECER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MISS
Other - First Name:VENUS
Other - Middle Name:CASENAS
Other - Last Name:COMBALECER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:15362 MORMON ST
Mailing Address - Street 2:
Mailing Address - City:BENNINGTON
Mailing Address - State:NE
Mailing Address - Zip Code:68007-1473
Mailing Address - Country:US
Mailing Address - Phone:402-445-4024
Mailing Address - Fax:402-445-4024
Practice Address - Street 1:15362 MORMON ST
Practice Address - Street 2:
Practice Address - City:BENNINGTON
Practice Address - State:NE
Practice Address - Zip Code:68007-1473
Practice Address - Country:US
Practice Address - Phone:402-445-4024
Practice Address - Fax:402-445-4024
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-01
Last Update Date:2009-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1078225X00000X
IA001885225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist