Provider Demographics
NPI:1407894082
Name:RAVEN HILL INTEGRATED THERAPIES, LLC
Entity type:Organization
Organization Name:RAVEN HILL INTEGRATED THERAPIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:KIRK
Authorized Official - Last Name:MOLATCH
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:207-664-6116
Mailing Address - Street 1:878 SUGAR HILL RD
Mailing Address - Street 2:
Mailing Address - City:EASTBROOK
Mailing Address - State:ME
Mailing Address - Zip Code:04634-4030
Mailing Address - Country:US
Mailing Address - Phone:207-664-6116
Mailing Address - Fax:207-664-6118
Practice Address - Street 1:185 STATE ST
Practice Address - Street 2:SUITES C&D
Practice Address - City:ELLSWORTH
Practice Address - State:ME
Practice Address - Zip Code:04605-1830
Practice Address - Country:US
Practice Address - Phone:207-664-6116
Practice Address - Fax:207-664-6118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOA633224Z00000X
MEOT1016225000000X, 225X00000X, 225XE1200X, 225XH1200X, 225XH1300X, 335E00000X
MEMT2661225700000X
MEOT307225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Multi-Specialty
No225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic FitterGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
No225XE1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistErgonomicsGroup - Multi-Specialty
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHandGroup - Multi-Specialty
No225XH1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHuman FactorsGroup - Multi-Specialty
No335E00000XSuppliersProsthetic/Orthotic SupplierGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMO-ME 1887Medicare ID - Type Unspecified
ME1558577023Medicare NSC