| Organization Name: | OCEANLAKE VETERINARY CLINIC, PC |
| NPI Number: | 1184081408 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JENNIFER ANNE MALTER (OWNER/VETERINARIAN) |
| Mailing Address: | 3545 Nw Highway 101 Lincoln City |
| State: | OR US |
| Postal Code: | 973675047 |
| Phone Number: | 5419942929 |
| Fax Number: | 5419947560 |
| NPI Enumeration Date: | 01/16/2016 |
| NPI Last Update Date: | 01/16/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 174M00000X |
| License Number: | 6457 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OR |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Veterinarian |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A doctor of veterinary medicine, trained and authorized to practice veterinarian medicine and surgery. |