Ketterhagen, Kelly Jo

Ketterhagen, Kelly Jo is an sole proprietor health care provider with primary practice located at N84W17049 Menomonee Ave , Menomonee Falls WI 53051-2701. She recently has only one registered license in Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Human Factors, which is considered as her primary health care specialty. Ketterhagen, Kelly Jo can be contacted via phone (262) 255-7050.

Contact Information

Primary practice address
N84W17049 Menomonee Ave Menomonee Falls WI 53051-2701
Phone: (262) 255-7050
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Human Factors 225XH1300X 4355-026 Wisconsin

Profile Details

NPI number 1043428287
LBN Legal business name Ketterhagen, Kelly Jo
Credentials MSOTR
Entity Individual
Sole proprietor 1 Yes
Enumeration date May 20th, 2007
Last updated Jul 8th, 2007 - about 18 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1043428287 NPPES
Wisconsin MEDICAID 40894900

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