Individual
PHAEDRA TRITON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
2103 GILMORE STREET, JACKSONVILLE, FL 32204
(904) 906-3878
Mailing address
2509 NORTH WATERLEAF DRIVE, ST. AUGUSTINE, FL 32092
(619) 366-0228
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
—
—
Other
Enumeration date
10/24/2024
Last updated
10/28/2024
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