Healthcare Provider Details

I. General information

NPI: 1003736661
Provider Name (Legal Business Name): GAVIN BARTELL LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

9621 MICKELBERRY RD NW STE 108
SILVERDALE WA
98383-8301
US

IV. Provider business mailing address

9621 MICKELBERRY RD NW STE 108
SILVERDALE WA
98383-8301
US

V. Phone/Fax

Practice location:
  • Phone: 360-692-5350
  • Fax: 360-692-5354
Mailing address:
  • Phone: 360-692-5350
  • Fax: 360-692-5354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMASS.MA.70149777
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: