Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | ||
Y | 225XG0600X | Occupational Therapist - Gerontology |
NPI | 1730783325 |
---|---|
Provider Name | Lisa Jean Cunha-Butkovich |
First Address | Chesapeake, VA 23322-9001 |
Second Address | Chesapeake, VA 23320-3728 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/11/2020 |
Last Update Date | 24/11/2020 |