Provider Demographics
NPI:1578077616
Name:OCEAN CITY NUTRITION
Entity Type:Organization
Organization Name:OCEAN CITY NUTRITION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED NUTRITION SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:BRICE
Authorized Official - Last Name:KLAVERWEIDEN
Authorized Official - Suffix:
Authorized Official - Credentials:CNS
Authorized Official - Phone:443-557-8411
Mailing Address - Street 1:301 BROOKVIEW DR
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-3907
Mailing Address - Country:US
Mailing Address - Phone:443-557-8411
Mailing Address - Fax:
Practice Address - Street 1:7040 MORRIS RD
Practice Address - Street 2:
Practice Address - City:PITTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21850-2188
Practice Address - Country:US
Practice Address - Phone:443-557-8411
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-28
Last Update Date:2017-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDCNS17179133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Single Specialty