Healthcare Provider Details

I. General information

NPI: 1225965361
Provider Name (Legal Business Name): MARISSA NICOLE EVERHART
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 05/05/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1026 DENMAN AVE
COSHOCTON OH
43812-2575
US

IV. Provider business mailing address

1026 DENMAN AVE
COSHOCTON OH
43812-2575
US

V. Phone/Fax

Practice location:
  • Phone: 330-260-9773
  • Fax: 330-260-9773
Mailing address:
  • Phone: 330-260-9773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberTZ934880
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: