| Doctor Name: | KELLY JO KETTERHAGEN |
| NPI Number: | 1043428287 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MSOTR |
| License Number: | 4355-026 |
| Business Practice Address: | N84w17049 Menomonee Ave Menomonee Falls, WI - 530512701 |
| Business Phone Number: | 2622557050 |
| Business Fax Number: | |
| Mailing Address: | 4685 Autumn Trl, RICHFIELD |
| State: | WI |
| Postal Code: | 530769419 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 05/20/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225XH1300X |
| License Number: | 4355-026 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WI |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Occupational Therapist |
| Taxonomy Specialization: | Human Factors |
| Taxonomy Definition: | |