Healthcare Provider Details

I. General information

NPI: 1407894082
Provider Name (Legal Business Name): RAVEN HILL INTEGRATED THERAPIES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 02/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 STATE ST SUITES C&D
ELLSWORTH ME
04605-1830
US

IV. Provider business mailing address

878 SUGAR HILL RD
EASTBROOK ME
04634-4030
US

V. Phone/Fax

Practice location:
  • Phone: 207-664-6116
  • Fax: 207-664-6118
Mailing address:
  • Phone: 207-664-6116
  • Fax: 207-664-6118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOA633
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License NumberOT1016
License Number StateME
# 3
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT2661
License Number StateME
# 4
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT1016
License Number StateME
# 5
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT307
License Number StateME
# 6
Primary TaxonomyN
Taxonomy Code225XE1200X
TaxonomyErgonomics Occupational Therapist
License NumberOT1016
License Number StateME
# 7
Primary TaxonomyN
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License NumberOT1016
License Number StateME
# 8
Primary TaxonomyN
Taxonomy Code225XH1300X
TaxonomyHuman Factors Occupational Therapist
License NumberOT1016
License Number StateME
# 9
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License NumberOT1016
License Number StateME

VIII. Authorized Official

Name: GREGORY KIRK MOLATCH
Title or Position: PRESIDENT
Credential: OTR/L
Phone: 207-664-6116