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General NPI Number Information
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NPI Number | 1184081408
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Entity Type | Organization
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Legal Business Name | OCEANLAKE VETERINARY CLINIC, PC
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Dates
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Enumeration Date | 01/16/2016
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Last Update Date | 01/16/2016
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Provider Practice Location Address
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Address Line | 3545 NW HIGHWAY 101
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City | LINCOLN CITY
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State | OR
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Zip | 97367-5047
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Country | US
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Telephone | 541-994-2929
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Fax | 541-994-7560
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Provider Business Mailing Address
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Address Line | 3545 NW HIGHWAY 101
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City | LINCOLN CITY
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State | OR
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Zip | 97367-5047
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Country | US
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Telephone | 541-994-2929
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Fax | 541-994-7560
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Authorized Official
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Title or Position | OWNER/VETERINARIAN
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Name | DR. JENNIFER ANNE MALTER
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Credential | DVM
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Telephone | 541-994-2929
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174M00000X
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Taxonomy Name | Veterinarian
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License Number | 6457
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License Number State | OR
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