Provider Demographics
NPI:1164734653
Name:MONTERO, STEPHANIE A (OTR)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:A
Last Name:MONTERO
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4441 VALLEY WILLOW WAY
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79922-1855
Mailing Address - Country:US
Mailing Address - Phone:915-873-1648
Mailing Address - Fax:877-587-9452
Practice Address - Street 1:1510 N ZARAGOZA RD STE A12
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-7893
Practice Address - Country:US
Practice Address - Phone:915-873-1648
Practice Address - Fax:877-587-9452
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-13
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX107303225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX149984001Medicaid
TX456606Medicare UPIN