Individual
KELLY JO KETTERHAGEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSOTR
Contact information
Practice address
N84W17049 MENOMONEE AVE, MENOMONEE FALLS, WI 53051-2701
(262) 255-7050
Mailing address
4685 AUTUMN TRL, RICHFIELD, WI 53076-9419
Taxonomy
Speciality
Code
Description
License number
State
225XH1300X
Human Factors Occupational Therapist
Primary
4355-026
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40894900
—
WI
Enumeration date
05/20/2007
Last updated
07/08/2007
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