MEDICARE: DR. RODNEY A POETTER PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PY0002970	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1174637268	OTHER	FL	GROUP NPI NUMBER
2	21827	OTHER	FL	BCBS GROUP
3	75184	OTHER		BCBS INDIV
4	1194823153	OTHER		NPI INDIV

General Provider Information

NPI Number	:	1194823153
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RODNEY A POETTER PH.D.

Provider Business Mailing Address
First Line	:	3002 SE 1ST AVE
Second Line	:	#200
City	:	OCALA
State	:	FL
Zip	:	34471-0477
Country	:	US
Telephone Number	:	352-351-5522
Fax Number	:	352-351-2950

Provider Business Practice Location Address
First Line	:	3002 SE 1ST AVE
Second Line	:	#200
City	:	OCALA
State	:	FL
Zip	:	34471-0477
Country	:	US
Telephone Number	:	352-351-5522
Fax Number	:	352-351-2950

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	11/18/2010

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1215180286 — MRS. NERINA SCIACCHITANO L.M.T
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Practice Fax:

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