Provider Demographics
NPI:1801180526
Name:BOLOGNA, LISA (OTR/L)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:BOLOGNA
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 HILLCREST PARK
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06870
Mailing Address - Country:US
Mailing Address - Phone:203-637-2227
Mailing Address - Fax:
Practice Address - Street 1:61 HILLCREST PARK RD
Practice Address - Street 2:
Practice Address - City:OLD GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06870-1019
Practice Address - Country:US
Practice Address - Phone:203-637-2227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-31
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist