Healthcare Provider Details

I. General information

NPI: 1205749405
Provider Name (Legal Business Name): JOLENE LAVERNE BOX RDH OMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

73 OAK DR
DORA AL
35062-4441
US

IV. Provider business mailing address

73 OAK DR
DORA AL
35062-4441
US

V. Phone/Fax

Practice location:
  • Phone: 205-527-2134
  • Fax:
Mailing address:
  • Phone: 205-527-2134
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: