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NPI Code Detail

MEDICARE: DAVID OTTO LMT

MEDICARE: DAVID OTTO LMT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225700000XMassage Therapist103NV

General Provider Information

NPI Number : 1124470638
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAVID OTTO LMT
Provider Business Mailing Address
First Line : 3683 LUCIDO DR UNIT 18
Second Line :
City : LAS VEGAS
State : NV
Zip : 89103-3609
Country : US
Telephone Number : 702-339-4325
Fax Number : 702-361-4838
Provider Business Practice Location Address
First Line : 3683 LUCIDO DR UNIT 18
Second Line :
City : LAS VEGAS
State : NV
Zip : 89103-3609
Country : US
Telephone Number : 702-339-4325
Fax Number : 702-361-4838
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/08/2016
Last Update Date : 07/08/2016

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Directions to “ DAVID OTTO LMT” Practice Location

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