Provider Demographics
NPI:1881633253
Name:MOLATCH, GREGORY KIRK (OTR)
Entity type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:KIRK
Last Name:MOLATCH
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
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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:207-565-8846
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-04
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MEOT1016225000000X, 225X00000X, 225XE1200X, 225XH1200X, 225XH1300X, 225XN1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter
No225XE1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistErgonomics
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
No225XH1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHuman Factors
No225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMO-ME 1887Medicare ID - Type Unspecified