| Miss Misty Star Bullock, | |
|
2032 S Frazier St, Philadelphia, PA 19143-5618 | |
| (267) 736-9099 | |
| Not Available |
| Full Name | Miss Misty Star Bullock |
|---|---|
| Gender | Female |
| Speciality | Occupational Therapist |
| Location | 2032 S Frazier St, Philadelphia, Pennsylvania |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639354335 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 225X00000X | Occupational Therapist | OC009582 (Pennsylvania) | Primary |
| 225X00000X | Occupational Therapist | OT11929 (Florida) | Secondary |
| Provider Name | Functional Pathways Preferred Of Tennessee Llc |
|---|---|
| Provider Type | Part B Supplier - Clinic/group Practice |
| Provider Identifiers | NPI Number: 1841561446 PECOS PAC ID: 2860649654 Enrollment ID: O20140903000068 |
| Provider Name | Cortlyn Therapy Pc |
|---|---|
| Provider Type | Part B Supplier - Physical/occupational Therapy Group In Private Practice |
| Provider Identifiers | NPI Number: 1235725730 PECOS PAC ID: 8729495684 Enrollment ID: O20220207001776 |
| Mailing Address | Practice Location Address |
|---|---|
| Miss Misty Star Bullock, 2032 S Frazier St, Philadelphia, PA 19143-5618 Ph: (267) 736-9099 | Miss Misty Star Bullock, 2032 S Frazier St, Philadelphia, PA 19143-5618 Ph: (267) 736-9099 |
June Terrell, OTR Occupational Therapist Medicare: Not Enrolled in Medicare Practice Location: 719 E Phil Ellena St, Philadelphia, PA 19119 Phone: 215-429-8002 Fax: 267-297-7337 | |
Shalyn Eakin, Occupational Therapist Medicare: Not Enrolled in Medicare Practice Location: 4040 Market St, Philadelphia, PA 19104 Phone: 814-440-7892 | |
Veronique Broussard, Occupational Therapist Medicare: Not Enrolled in Medicare Practice Location: 632 W Naomi St, Philadelphia, PA 19144 Phone: 267-245-2601 | |
Evan Kirby, MS, OTR/L Occupational Therapist Medicare: Not Enrolled in Medicare Practice Location: 6595b Roosevelt Blvd, Philadelphia, PA 19149 Phone: 215-743-2332 | |
The Center For Autism Occupational Therapist Medicare: Not Enrolled in Medicare Practice Location: 3905 Ford Rd, Suite 6, Philadelphia, PA 19131 Phone: 215-878-3400 Fax: 215-878-2082 | |
Ms. Sarah E Kauper, MS, OTR/L Occupational Therapist Medicare: Medicare Enrolled Practice Location: 1832 Catharine St, Philadelphia, PA 19146 Phone: 248-408-0741 | |
Stc Pediatrics Llc Occupational Therapist Medicare: Not Enrolled in Medicare Practice Location: 160 E Erie Ave, Philadelphia, PA 19134 Phone: 215-427-5494 |