MEDICARE: VESTIBULAR INSTITUTE

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

General Provider Information

NPI Number	:	1801197439
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VESTIBULAR INSTITUTE

Provider Business Mailing Address
First Line	:	PO BOX 30664
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89173-0664
Country	:	US
Telephone Number	:	702-616-1605
Fax Number	:	702-616-0967

Provider Business Practice Location Address
First Line	:	8530 W CHARLESTON BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-1238
Country	:	US
Telephone Number	:	702-363-2336
Fax Number	:	702-877-3874

Authorized Official
Title or Position	:	OWNER
Name	:	DR. WALTER C OTTO
Credential	:	PH.D
Telephone Number	:	702-363-2336

Provider Enumeration Date	:	11/12/2010
Last Update Date	:	03/29/2011

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Directions to “VESTIBULAR INSTITUTE ” Practice Location

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