Provider Demographics
NPI:1033759998
Name:RASEL, JAMES MICHAEL
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:MICHAEL
Last Name:RASEL
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:JAMES
Other - Middle Name:MICHAEL
Other - Last Name:RASEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:730 E CHURCH ST STE 12
Mailing Address - Street 2:
Mailing Address - City:MARTINSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24112-3151
Mailing Address - Country:US
Mailing Address - Phone:540-488-5594
Mailing Address - Fax:
Practice Address - Street 1:730 E CHURCH ST STE 12
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24112-3151
Practice Address - Country:US
Practice Address - Phone:540-488-5594
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-08
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2101001850237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist