Individual
OLIVIA N TISCKOS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1122 WEST AVE APT 1, NORMAL, IL 61761-3472
(217) 971-0937
Mailing address
239 YEOMAN DR, SPRINGFIELD, IL 62704-5246
(217) 971-0937
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
096005607
IL
Other
Enumeration date
04/21/2022
Last updated
06/18/2025
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