Otis Winston Clark, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

7643 Issued in SC

Practice address

3250 Harden Street Ext
Suite 100
Columbia, SC 29203-6842

Phone

(803) 509-6389

Fax

(803) 509-6390

NPI assigned

Jun 25, 2010

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Drayer Physical Therapy Georgia LLC

  • Physical Therapist
  • Monroe, GA
  • NPI 1568890382
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1277424000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1421366400000",
    "number": "1477864312",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3250 HARDEN STREET EXT",
            "address_2": "SUITE 100",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292036842",
            "telephone_number": "803-509-6389",
            "fax_number": "803-509-6390"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3250 HARDEN STREET EXT",
            "address_2": "SUITE 100",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292036842",
            "telephone_number": "803-509-6389",
            "fax_number": "803-509-6390"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "OTIS",
        "middle_name": "WINSTON",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-06-25",
        "last_updated": "2015-01-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "GA",
            "license": "PT009950",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "SC",
            "license": "7643",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lindsey Anne Clark
• Lisa L. Clark, APRN
• Lucille Clark, PHARMD
• Megan Nicole Clark
• Milana Francesca Clark
• Sienna Marie Elizabeth Clark, DPT
• Tresvant Llewellyn Clark
• April Tamara Singleton Clarke, MD
• Marlon Alando Clarke, M.D
• Francis Ancrum Clarkson, M.D

• Physical Therapist in Columbia, SC
• Providers in Columbia, SC by specialty
• Physical Therapist in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.