Provider Demographics
NPI:1780881771
Name:PUNZAL, SWEET CHARITY TAN (OTR)
Entity type:Individual
Prefix:MISS
First Name:SWEET CHARITY
Middle Name:TAN
Last Name:PUNZAL
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 W SKYWAY DR
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47303-1151
Mailing Address - Country:US
Mailing Address - Phone:765-461-6040
Mailing Address - Fax:
Practice Address - Street 1:2200 W WHITE RIVER BLVD
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47303-5242
Practice Address - Country:US
Practice Address - Phone:765-289-3341
Practice Address - Fax:765-289-3511
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31004162A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist