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General NPI Number Information
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NPI Number | 1861872582
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Entity Type | Individual
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Provider Name | NICOLE RENEE DEISHER LISW-S
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Gender | Female
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Dates
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Enumeration Date | 06/08/2015
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Last Update Date | 08/28/2025
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Provider Practice Location Address
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Address Line | 1027 SOUTH TRIMBLE RD
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City | MANSFIELD
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State | OH
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Zip | 44906
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Country | US
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Telephone | 419-774-6400
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Fax |
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Provider Business Mailing Address
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Address Line | 144 OTTERBEIN DR
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City | LEXINGTON
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State | OH
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Zip | 44904-9783
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Country | US
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Telephone | 419-612-8474
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2251S0007X
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Taxonomy Name | Sports Physical Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | I.1500558
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License Number State | OH
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