Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Lisa Rosario Kolmanovskiy, OTR/L

Individual provider Occupational Therapist · NPI 1790454411

Lisa Rosario Kolmanovskiy, OTR/L is an Occupational Therapist in Private Practice in Menlo Park, California. Qualified in 2020, 6 years ago. Licensed in California.

Years since qualifying
6
Licensed in
CA
In the registry since
2021
What do these letters mean?
OTR/L — Occupational Therapist, Registered and Licensed
An occupational therapist who is both nationally registered and state licensed.

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Practice location Address checks out

825 Oak Grove Ave Ste A102
Menlo Park, CA 94025-4427
Phone: (650) 323-0805
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Occupational Therapist (primary) Taxonomy 225X00000X · Licence 22506 (CA)

Record details

NPI number1790454411
Entity typeIndividual (Type 1)
GenderFemale
Credentials OTR/L
Sole proprietorNo
NPI enumeratedSeptember 7, 2021
Last updated in NPPESJuly 31, 2023
Certification dateJuly 30, 2023

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyOCCUPATIONAL THERAPIST IN PRIVATE PRACTICE
Medical schoolOTHER
Graduated 2020 (6 years in practice)
Accepts Medicare assignment Not indicated

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