Kelly Jo Ketterhagen, MSOTR

Primary specialty

Human Factors Occupational TherapistTaxonomy code 225XH1300X

License

4355-026 Issued in WI

Practice address

N84W17049 Menomonee Ave
Menomonee Falls, WI 53051-2701

Phone

(262) 255-7050

NPI assigned

May 20, 2007

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

Specialty

Occupational Therapist in Private Practice

Education

Other, 2005

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Fox Rehabilitation Services Wi LLCGroup PAC ID 1658647581, 144 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Fox Rehabilitation Services Wi LLC

  • Physical Therapist
  • Milwaukee, WI
  • NPI 1518483973
  Medicare reassignment Care Compare group NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1179619200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1043428287",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4685 AUTUMN TRL",
            "city": "RICHFIELD",
            "state": "WI",
            "postal_code": "530769419"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "N84W17049 MENOMONEE AVE",
            "city": "MENOMONEE FALLS",
            "state": "WI",
            "postal_code": "530512701",
            "telephone_number": "262-255-7050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KETTERHAGEN",
        "first_name": "KELLY JO",
        "credential": "MSOTR",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-05-20",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225XH1300X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Human Factors",
            "state": "WI",
            "license": "4355-026",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "40894900",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Alicia S Kelch, PA-C
• Matthew B Kells
• Tara Kennedy, M.D.
• Peter Kenny, PHD
• Thomas Alan Kent, MSW
• Sunita Khambatta, M.D.
• Mubeen A Khan
• Paramjeet Singh Kharag
• Linda Kiatoukaysy, M.D.
• Baedero Kim

• Occupational Therapist in Menomonee Falls, WI
• Providers in Menomonee Falls, WI by specialty
• Occupational Therapist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.