Provider Demographics
NPI:1346570280
Name:OFELT, DANIKA G (RD)
Entity Type:Individual
Prefix:
First Name:DANIKA
Middle Name:G
Last Name:OFELT
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:922 NW CIRCLE BLVD STE 160-219
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-1483
Mailing Address - Country:US
Mailing Address - Phone:541-243-3665
Mailing Address - Fax:541-224-5277
Practice Address - Street 1:922 NW CIRCLE BLVD STE 160-219
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-1483
Practice Address - Country:US
Practice Address - Phone:541-243-3665
Practice Address - Fax:541-224-5277
Is Sole Proprietor?:No
Enumeration Date:2009-12-27
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI60116670133V00000X
AKDTND310133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500778042Medicaid