Provider Demographics
NPI:1134424138
Name:CICHACKI-ROMERSA, LISA
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:CICHACKI-ROMERSA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1060 TWIN DOLPHIN DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94065-1133
Mailing Address - Country:US
Mailing Address - Phone:650-631-9999
Mailing Address - Fax:
Practice Address - Street 1:ARBOR BAY SCHOOL
Practice Address - Street 2:1017 CEDAR ST.
Practice Address - City:SAN CARLOS
Practice Address - State:CA
Practice Address - Zip Code:94070
Practice Address - Country:US
Practice Address - Phone:650-631-9999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-21
Last Update Date:2019-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOTR 8415225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist