Healthcare Provider Details

I. General information

NPI: 1346570280
Provider Name (Legal Business Name): DANIKA G OFELT RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2009
Last Update Date: 12/22/2020
Certification Date: 12/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

922 NW CIRCLE BLVD STE 160-219
CORVALLIS OR
97330-1483
US

IV. Provider business mailing address

922 NW CIRCLE BLVD STE 160-219
CORVALLIS OR
97330-1483
US

V. Phone/Fax

Practice location:
  • Phone: 541-243-3665
  • Fax: 541-224-5277
Mailing address:
  • Phone: 541-243-3665
  • Fax: 541-224-5277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDI60116670
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: