Provider Demographics
NPI:1730783325
Name:CUNHA-BUTKOVICH, LISA JEAN (OTR/L)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:JEAN
Last Name:CUNHA-BUTKOVICH
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 1:813 CHALBOURNE DR
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23322-9001
Mailing Address - Country:US
Mailing Address - Phone:757-717-5522
Mailing Address - Fax:
Practice Address - Street 1:776 OAK GROVE RD
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-3728
Practice Address - Country:US
Practice Address - Phone:757-389-7900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-24
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist