Healthcare Provider Details

I. General information

NPI: 1861872582
Provider Name (Legal Business Name): NICOLE RENEE DEISHER LISW-S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NICOLE RENEE FUHRHOP LISW

II. Dates (important events)

Enumeration Date: 06/08/2015
Last Update Date: 08/28/2025
Certification Date: 08/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1027 SOUTH TRIMBLE RD
MANSFIELD OH
44906
US

IV. Provider business mailing address

144 OTTERBEIN DR
LEXINGTON OH
44904-9783
US

V. Phone/Fax

Practice location:
  • Phone: 419-774-6400
  • Fax:
Mailing address:
  • Phone: 419-612-8474
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.1500558
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: