Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Miss. Misty Star Bullock

Individual provider Occupational Therapist · NPI 1639354335

Miss. Misty Star Bullock is an Occupational Therapist in Philadelphia, Pennsylvania. Practices as a sole proprietor. Licensed in Florida and Pennsylvania.

Licensed in
FL, PA
In the registry since
2008
Specialties on file
2
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Practice location Address checks out

2032 S Frazier St
Philadelphia, PA 19143-5618
Phone: (267) 736-9099
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Occupational Therapist (primary) Taxonomy 225X00000X · Licence OC009582 (PA)
Occupational Therapist Taxonomy 225X00000X · Licence OT11929 (FL)

Record details

NPI number1639354335
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorYes
NPI enumeratedJanuary 1, 2008
Last updated in NPPESJanuary 1, 2008

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