MISTY STAR BULLOCK

PHILADELPHIA, PA
NPI1639354335
Entity TypeIndividual
GenderFemale
Sole Proprietor ?Yes
Primary Taxonomy225X00000X Occupational Therapist
(Licence: PA  OC009582)
Additional Taxonomies225X00000X Occupational Therapist
(Licence: FL  ot11929)
Enumeration Date2008-01-01
Last Update Date2008-01-01
Business Address
Miss MISTY STAR BULLOCK
2032 S FRAZIER ST
PHILADELPHIA, PA 19143-5618
Phone number: 267-736-9099
Mailing Address
Miss MISTY STAR BULLOCK
2032 S FRAZIER ST
PHILADELPHIA, PA 19143-5618
Phone number: 267-736-9099