Healthcare Provider Details

I. General information

NPI: 1801703152
Provider Name (Legal Business Name): INSPIRE INDEPENDENCE THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20527 130TH AVE SE
RED LAKE FALLS MN
56750-8804
US

IV. Provider business mailing address

20527 130TH AVE SE
RED LAKE FALLS MN
56750-8804
US

V. Phone/Fax

Practice location:
  • Phone: 218-686-4054
  • Fax:
Mailing address:
  • Phone: 218-686-4054
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: LACEY KONICKSON
Title or Position: MANAGING MEMBER/OWNER
Credential: MOT, OTR/L, CLT
Phone: 218-686-4054