Provider Demographics
NPI:1780852855
Name:MCGOVERN, LISA BUTTERBAUGH (MS, OTR)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:BUTTERBAUGH
Last Name:MCGOVERN
Suffix:
Gender:F
Credentials:MS, OTR
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:BUTTERBAUGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, OTR
Mailing Address - Street 1:5705 E 81ST ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-1723
Mailing Address - Country:US
Mailing Address - Phone:574-276-1180
Mailing Address - Fax:
Practice Address - Street 1:5705 E 81ST ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250
Practice Address - Country:US
Practice Address - Phone:574-276-1180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-12
Last Update Date:2018-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31004500A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist