Provider Demographics
NPI:1073846549
Name:SAGE HILL THERAPY SERVICES PC
Entity Type:Organization
Organization Name:SAGE HILL THERAPY SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:R
Authorized Official - Last Name:GRADEN
Authorized Official - Suffix:
Authorized Official - Credentials:MS,OTR/L
Authorized Official - Phone:406-360-2068
Mailing Address - Street 1:15853 QUEEN ANNES LN
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:MT
Mailing Address - Zip Code:59833-5940
Mailing Address - Country:US
Mailing Address - Phone:406-360-2068
Mailing Address - Fax:406-777-5621
Practice Address - Street 1:800 KENSINGTON AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-5674
Practice Address - Country:US
Practice Address - Phone:406-360-2068
Practice Address - Fax:406-777-5621
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-15
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT944225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT3401836Medicaid
MT662570OtherMT BLUE CROSS BLUE SHIELD
MT944OtherOT LICENSE