Provider Demographics
NPI:1275294258
Name:MONTERO, MARIA STEPHANIE (OTD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:STEPHANIE
Last Name:MONTERO
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:STEPHANIE
Other - Last Name:CARNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:152 W 500 N
Mailing Address - Street 2:
Mailing Address - City:JEROME
Mailing Address - State:ID
Mailing Address - Zip Code:83338-5029
Mailing Address - Country:US
Mailing Address - Phone:575-652-1889
Mailing Address - Fax:
Practice Address - Street 1:2550 ADDISON AVE E STE D
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-6748
Practice Address - Country:US
Practice Address - Phone:208-814-7950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-03
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDOTL-2510225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDOTL2510OtherIDAHO DIVISION OF OCCUPATIONAL AND PROFESSIONAL LICENSES