Healthcare Provider Details

I. General information

NPI: 1407140874
Provider Name (Legal Business Name): DJO CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2011
Last Update Date: 06/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2010 HOGBACK RD SUITE 2-A
ANN ARBOR MI
48105-9749
US

IV. Provider business mailing address

2010 HOGBACK RD SUITE 2-A
ANN ARBOR MI
48105-9749
US

V. Phone/Fax

Practice location:
  • Phone: 734-468-3746
  • Fax: 734-531-5312
Mailing address:
  • Phone: 734-468-3746
  • Fax: 734-531-5312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DONALD J. OTTOMEYER
Title or Position: PRESIDENT
Credential:
Phone: 734-468-3746