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NPI Code Detail

MEDICARE: WILL DERUYTER

MEDICARE: WILL DERUYTER
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1033049556
Entity Type Code : Individual
Provider Name (Legal Business Name) : WILL DERUYTER
Provider Business Mailing Address
First Line : 2550 N HOLLYWOOD WAY STE 301
Second Line :
City : BURBANK
State : CA
Zip : 91505-5025
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2248 MOUNT HOPE RD
Second Line :
City : OKEMOS
State : MI
Zip : 48864-2570
Country : US
Telephone Number : 844-263-1613
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/19/2026
Last Update Date : 05/19/2026

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Directions to “ WILL DERUYTER ” Practice Location

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