Healthcare Provider Details

I. General information

NPI: 1427716448
Provider Name (Legal Business Name): STEFANIE LOPEZ MONTANO OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2021
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 HUEBNER RD
FT RILEY KS
66442-4030
US

IV. Provider business mailing address

650 HUEBNER RD
FT RILEY KS
66442-4030
US

V. Phone/Fax

Practice location:
  • Phone: 785-239-3627
  • Fax:
Mailing address:
  • Phone: 785-239-3627
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT-1854
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number118995
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: