KELLY JO KETTERHAGEN (MSOTR) – Human Factors Occupational Therapist, NPI 1043428287
Human Factors Occupational Therapist
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
500 OCCUPATIONAL THERAPIST IN PRIVATE PRACTICE in WI
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Provider Addresses for KELLY JO KETTERHAGEN (MSOTR)
N84W17049, Menomonee Avenue, Menomonee Falls, Waukesha County, Wisconsin, 53051, United States
MENOMONEE FALLS, WI 530512701
Phone: (262) 255-7050
Type: Location
4685, Autumn Trail, Village of Richfield, Washington County, Wisconsin, 53076, United States
RICHFIELD, WI 530769419
Phone:
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
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Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2019-08-15
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20190815001655 | I | Occupational Therapist In Private Practice | WI | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 97535 | Training for self-care or home management, each 15 minutes | 410 | 31 | $0 |
| 97530 | Therapy procedure using functional activities | 315 | 29 | $0 |
| 97110 | Therapy procedure using exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes | 213 | 23 | $0 |
| 97166 | Evaluation for occupational therapy, typically 45 minutes | 17 | 15 | $0 |
Insurance plans in this area (ZIP 53051)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Physical Therapist In Private Practice | MI | |
| Qualified Speech Language Pathologist | WI | |
| Occupational Therapist In Private Practice | WI | |
| Physical Therapist In Private Practice | MI | |
| Occupational Therapist In Private Practice | WI | |
| Occupational Therapist In Private Practice | NJ | |
| Occupational Therapist In Private Practice | WI | |
| Occupational Therapist In Private Practice | NJ | |
| Qualified Speech Language Pathologist | WI | |
| Occupational Therapist In Private Practice | WI |
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