Provider Demographics
NPI:1710639612
Name:BUNTING, RYAN EDWARD (COTA/L)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:EDWARD
Last Name:BUNTING
Suffix:
Gender:M
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 SUTTON FARM RD
Mailing Address - Street 2:
Mailing Address - City:FLEMINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08822-2725
Mailing Address - Country:US
Mailing Address - Phone:908-938-1698
Mailing Address - Fax:
Practice Address - Street 1:1 SUTTON FARM RD
Practice Address - Street 2:
Practice Address - City:FLEMINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08822-2725
Practice Address - Country:US
Practice Address - Phone:908-938-1698
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-21
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TA09218000224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant