Provider Demographics
NPI:1609240449
Name:STAAL, KAITLYN (ND, MSAC)
Entity Type:Individual
Prefix:DR
First Name:KAITLYN
Middle Name:
Last Name:STAAL
Suffix:
Gender:F
Credentials:ND, MSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 N STONINGTON RD
Mailing Address - Street 2:
Mailing Address - City:STONINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06378-1514
Mailing Address - Country:US
Mailing Address - Phone:631-833-0467
Mailing Address - Fax:203-717-0214
Practice Address - Street 1:125 BOSTON POST RD
Practice Address - Street 2:SUITE #1
Practice Address - City:WATERFORD
Practice Address - State:CT
Practice Address - Zip Code:06385-2841
Practice Address - Country:US
Practice Address - Phone:631-833-0467
Practice Address - Fax:203-717-0214
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-17
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT553175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath