Healthcare Provider Details

I. General information

NPI: 1700630043
Provider Name (Legal Business Name): ABBEY MICHELLE NIEDERMIER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2024
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1033 LARCHWOOD RD
MANSFIELD OH
44907-2424
US

IV. Provider business mailing address

1885 CHAPELWOOD BLVD APT 8
MANSFIELD OH
44907-2269
US

V. Phone/Fax

Practice location:
  • Phone: 419-747-4122
  • Fax:
Mailing address:
  • Phone: 567-275-3303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.2613685
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: