Provider Demographics
NPI:1356553721
Name:BUNTON, ROSEMARY W (COTA)
Entity type:Individual
Prefix:MRS
First Name:ROSEMARY
Middle Name:W
Last Name:BUNTON
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1204 HAMPSTEAD LN
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-1446
Mailing Address - Country:US
Mailing Address - Phone:386-677-0478
Mailing Address - Fax:
Practice Address - Street 1:1204 HAMPSTEAD LN
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-1446
Practice Address - Country:US
Practice Address - Phone:386-677-0478
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA9859171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor