Provider Demographics
NPI:1205298171
Name:BOURASSA, MARC (HAS)
Entity type:Individual
Prefix:
First Name:MARC
Middle Name:
Last Name:BOURASSA
Suffix:
Gender:M
Credentials:HAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:149 PLANTATION RIDGE DR STE 140
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-9175
Mailing Address - Country:US
Mailing Address - Phone:561-434-9944
Mailing Address - Fax:
Practice Address - Street 1:5333 N DIXIE HWY STE 105
Practice Address - Street 2:
Practice Address - City:OAKLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:33334-3449
Practice Address - Country:US
Practice Address - Phone:954-889-5920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-22
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAS5165237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist