Lisa Rosario Kolmanovskiy, OTR/L

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

22506 Issued in CA

Practice address

825 Oak Grove Ave Ste A102
Menlo Park, CA 94025-4427

Phone

(650) 323-0805

NPI assigned

Sep 7, 2021

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Lisa Rivera Rosario Former name

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Specialty

Occupational Therapist in Private Practice

Education

Other, 2020

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Permanente Medical Group Inc

  • Internal Medicine Physician
  • Santa Clara, CA
  • NPI 1073606299
  Medicare reassignment
• County of Santa Clara

  dba Inpatient Acute/Outpatient Facility Services

  • General Acute Care Hospital
  • San Jose, CA
  • NPI 1063406551
  NPD (past)
• Integrated Intervention for Children With Autism

  • Speech-Language Pathologist
  • San Jose, CA
  • NPI 1669725834
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1630972800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690761600000",
    "number": "1790454411",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "188 HACKAMORE CMN",
            "city": "FREMONT",
            "state": "CA",
            "postal_code": "945397477",
            "telephone_number": "408-476-3717"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "825 OAK GROVE AVE STE A102",
            "city": "MENLO PARK",
            "state": "CA",
            "postal_code": "940254427",
            "telephone_number": "650-323-0805"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOLMANOVSKIY",
        "first_name": "LISA",
        "middle_name": "ROSARIO",
        "credential": "OTR/L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-09-07",
        "last_updated": "2023-07-31",
        "certification_date": "2023-07-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "CA",
            "license": "22506",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LISA",
            "last_name": "ROSARIO",
            "middle_name": "RIVERA",
            "credential": "OTR/L",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Peter A Klein, PH D
• Aurel Kleinerman, M.D., PH.D.
• Gilbert Harrow Kliman, M.D.
• Jeffrey Schreiber Kline, PH.D.
• Rebecca Therese Knebel-Bhatt, DPT
• Bryan Kolozsi, D.C.
• David Kong, DC
• Maya Leba Kopell, M.D.
• Benjamin Kovachy, MD
• Edward Miklos Kovachy Jr., M.D.

• Occupational Therapist in Menlo Park, CA
• Providers in Menlo Park, CA by specialty
• Occupational Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.