Provider Demographics
NPI:1801197439
Name:VESTIBULAR INSTITUTE
Entity type:Organization
Organization Name:VESTIBULAR INSTITUTE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:C
Authorized Official - Last Name:OTTO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:702-363-2336
Mailing Address - Street 1:PO BOX 30664
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89173-0664
Mailing Address - Country:US
Mailing Address - Phone:702-616-1605
Mailing Address - Fax:702-616-0967
Practice Address - Street 1:8530 W CHARLESTON BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-1238
Practice Address - Country:US
Practice Address - Phone:702-363-2336
Practice Address - Fax:702-877-3874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-12
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty