MEDICARE: WALTER C. OTTO PH.D.

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
1	231H00000X	Audiologist	A-138	NV

General Provider Information

NPI Number	:	1508993064
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WALTER C. OTTO PH.D.

Provider Business Mailing Address
First Line	:	408 COURTNEY LN
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89107-2429
Country	:	US
Telephone Number	:	702-363-2336
Fax Number	:	702-877-3874

Provider Business Practice Location Address
First Line	:	1750 S RAINBOW BLVD STE 2
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-2949
Country	:	US
Telephone Number	:	702-363-2336
Fax Number	:	702-877-3874

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/28/2007
Last Update Date	:	07/08/2007

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