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Individual
OTIS WINSTON CLARK
Active
Individual
OTIS WINSTON CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
7643
SC
225100000X
Physical Therapist
PT009950
GA
Other
Enumeration date
06/25/2010
Last updated
01/16/2015
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