Olivia N Tisckos
Specialist/Technologist, Athletic Trainer in Normal, IL. Individual provider (NPI-1).
NPI number1154065670
StatusActive
Last updated in NPPESJun 18, 2025
Details
- NPI
- 1154065670
- Entity type
- Individual (NPI-1)
- Name
- Olivia N Tisckos
- Sex
- Female
- Sole proprietor
- Yes
- Enumeration date
- Apr 21, 2022
- Certification date
- Jun 18, 2025
- Last updated
- Jun 18, 2025
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 2255A2300X | Specialist/Technologist, Athletic Trainer | 096005607 | IL | Yes |
Practice location
1122 West Ave Apt 1Normal, IL 61761-3472
Phone 217-971-0937
Mailing address
239 Yeoman DrSpringfield, IL 62704-5246
Phone 217-971-0937
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This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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