Individual
OTIS WINSTON CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
3250 HARDEN STREET EXT, SUITE 100, COLUMBIA, SC 29203-6842
(803) 509-6389
(803) 509-6390
Mailing address
3250 HARDEN STREET EXT, SUITE 100, COLUMBIA, SC 29203-6842
(803) 509-6389
(803) 509-6390
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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