Occupational Therapist Licensing: NBCOT, Fieldwork and States

How to get an occupational therapist license

1. 1

   Complete an ACOTE-accredited programme

   Finish a master's or entry-level doctoral degree accredited by the Accreditation Council for Occupational Therapy Education. Both routes qualify, so choose on career intent rather than assuming a doctorate is required.

2. 2

   Complete Level II fieldwork

   Undertake the required full-time supervised fieldwork placements across practice settings. This is a prerequisite for the certification examination and cannot be replaced by employment experience, so plan placements carefully with your programme.

3. 3

   Pass the NBCOT examination

   Sit the certification examination covering information gathering about client factors and contexts, formulating conclusions about client needs, selecting and implementing interventions, and competency and practice management. Passing confers the OTR credential.

4. 4

   Apply for state licensure

   Submit your application to the state occupational therapy board with certification verification, a background check and the jurisprudence requirement most states impose. Licensure is required in every state before you may practise.

5. 5

   Maintain both credentials and specialise

   Keep NBCOT certification current through its renewal requirements and renew your state licence separately. Consider hand therapy certification or an association specialty credential in paediatrics, gerontology, mental health or low vision as you develop a practice area.

Occupational Therapist license requirements

Requirements combine accredited education, fieldwork, national certification and state licensure. You need:

How much an occupational therapist license costs

Licensure costs are modest next to the degree. Budget for:

The occupational therapist license exam

The NBCOT certification examination covers acquiring information about client factors and contexts, formulating conclusions about client needs, selecting and implementing interventions, and competency and practice management including professional standards and documentation. It is scored against a scaled standard rather than a percentage, and eligibility requires graduation from an ACOTE-accredited programme and completion of Level II fieldwork — which is why the fieldwork requirement cannot be deferred. Passing confers the Occupational Therapist Registered credential. Most states then add a jurisprudence examination or attestation on their own practice act, which is separate from the national examination and specific to each state.

How long it takes to get licensed

Six to seven years including the undergraduate degree, with the accredited programme and its full-time fieldwork the substantive part.

Occupational Therapist license types: the full ladder

The occupational therapy ladder runs from assistant through therapist to specialty certification.

Occupational therapist vs Physical therapist: occupational therapist license

Occupational Therapist license reciprocity between states

NBCOT certification is national and travels with no transfer process, which removes the qualification question from relocating. State licensure is separate in each state and does not transfer, though because every state builds on the same national certification the process is administrative — an application, background check, fee and usually a jurisprudence element. An occupational therapy compact has been developing to provide multi-state privileges but has not reached the maturity of the physical therapy compact, so check its current operational status rather than assuming it applies.

Occupational Therapistsalary & job outlook

Occupational therapists earn a median of about $100,330 per year ($48.24/hour), with home health, skilled nursing and hand therapy specialisation typically above outpatient and school-based practice. Employment is projected to grow 13.8%, with roughly 10,200 openings a year. See the full occupational therapist salary guide for pay by state, city and experience level.

Occupational Therapist license requirements by state

Every state licenses occupational therapists, so what differs is the jurisprudence requirement, supervision rules for assistants and continuing competence obligations.

All states license occupational therapists, most through a dedicated occupational therapy board or a combined therapy board. The differences are the jurisprudence requirement, the supervision rules governing occupational therapy assistants, continuing competence requirements, and whether the state has joined the emerging occupational therapy compact. Confirm with the board where you will practise.

Browse all state guides

Occupational Therapist license FAQs

BLS Occupational Outlook Handbook (Occupational Therapists) · National Board for Certification in Occupational Therapy (NBCOT) · ACOTE, Accreditation Council for Occupational Therapy Education · U.S. Bureau of Labor Statistics, OEWS May 2025 (29-1122). Requirements and fees are set per state and change, confirm with your state board before applying.

Licensed occupational therapist? Find a job.

We verify your state license and match you with permanent employers. License renewal fees paid after placement.