Provider Demographics
NPI:1083196463
Name:BOLMAN, LISA M (OTD OTR/L)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:M
Last Name:BOLMAN
Suffix:
Gender:F
Credentials:OTD OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25139 BRIDGETON DR
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-1709
Mailing Address - Country:US
Mailing Address - Phone:440-623-0838
Mailing Address - Fax:
Practice Address - Street 1:2529 DETROIT AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44113-2701
Practice Address - Country:US
Practice Address - Phone:440-623-0838
Practice Address - Fax:216-927-1801
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-03
Last Update Date:2018-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT010199225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist