Provider Demographics
NPI:1619326063
Name:PERTAIN, CLARK III (OTR/L)
Entity Type:Individual
Prefix:MR
First Name:CLARK
Middle Name:
Last Name:PERTAIN
Suffix:III
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:238 DANIEL WEBSTER HWY
Mailing Address - Street 2:
Mailing Address - City:MEREDITH
Mailing Address - State:NH
Mailing Address - Zip Code:03253-5803
Mailing Address - Country:US
Mailing Address - Phone:603-279-7208
Mailing Address - Fax:603-279-7808
Practice Address - Street 1:238 DANIEL WEBSTER HWY
Practice Address - Street 2:
Practice Address - City:MEREDITH
Practice Address - State:NH
Practice Address - Zip Code:03253-5803
Practice Address - Country:US
Practice Address - Phone:603-279-7208
Practice Address - Fax:603-279-7808
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-07
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0988225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist