Healthcare Provider Details

I. General information

NPI: 1326486242
Provider Name (Legal Business Name): OTTOBOCK MEDICALCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2013
Last Update Date: 07/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14800 28TH AVE N SUITE 110-A
MINNEAPOLIS MN
55447-4873
US

IV. Provider business mailing address

2 CARLSON PKWY N SUITE 100
MINNEAPOLIS MN
55447-4466
US

V. Phone/Fax

Practice location:
  • Phone: 800-328-4058
  • Fax: 763-253-5779
Mailing address:
  • Phone: 763-253-5679
  • Fax: 763-253-5779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MRS. SHARON CLARK
Title or Position: MANAGER
Credential:
Phone: 763-253-5679