Occupational Therapist Salary in Houston, TX 2026,
$103,580 Median | BLS + Market Data

Houston occupational therapists earn a BLS median of $103,580/yr, or $49.80 an hour, across the Houston-Pasadena-The Woodlands metro, with a published band from $78,790 to $140,720. That is 3.2% above the US median for the occupation, with no state income tax applied. BLS counts 2,700 occupational therapists in the metro.

No — the metro sits 2.4% below the Texas statewide figure, which surprises people given how much rehabilitation capacity is concentrated here. Occupational therapy pay follows reimbursement rather than metropolitan wage levels, and Texas markets with heavier post-acute mixes lift the state figure. Among peer metros Houston sits below Atlanta at $106,160, Dallas at $106,110, Phoenix at $105,060 and Philadelphia at $103,140, and above Miami at $101,480.

Home health and skilled nursing, followed by inpatient rehabilitation and specialist hospital caseloads. Post-acute settings are reimbursed per episode and compete for therapists willing to accept productivity targets and travel between sites, which is what pushes them to the top of this band. Specialist hospital practice — certified hand therapy, neurological rehabilitation, assistive technology and seating — reaches the upper quarter through credentialling rather than volume. Paediatric and school-based work sits lowest.

Through the Texas Board of Occupational Therapy Examiners, which operates under the Executive Council of Physical Therapy and Occupational Therapy Examiners and licenses statewide. The route requires a degree from an ACOTE-accredited master's or doctoral programme, completion of supervised fieldwork, passage of the NBCOT certification examination, and a Texas jurisprudence assessment. The licence covers practice anywhere in the state; Houston issues no separate credential.

It is a strong market. The median sits above the national figure, there is no state income tax, housing is moderate, and projected national growth of 13.8% is reinforced locally by one of the fastest regional population growth rates in the country. The honest caveats are the same as everywhere in the profession: entry now requires a master's or doctoral degree with the debt that implies, and the best-paid settings are post-acute rather than the prestigious rehabilitation institutions many graduates aim for.

The counterintuitive order on this page — post-acute above hospitals — is how occupational therapy is funded rather than a Houston peculiarity. Skilled nursing and home health are paid per episode under Medicare and must compete for therapists willing to accept the productivity expectations attached. Hospital practice is salaried against internal grade structures. School and early intervention work is funded by education and state programme budgets set without reference to the therapy labour market at all. A therapist's income here is determined largely by which of those systems is paying them.

This metro is enormous and dispersed, and for home health therapists that is a working condition rather than a background fact. Visit-based earnings depend on how many patients can realistically be seen in a day, which depends on how tightly a territory is clustered. Therapists who negotiate territory carefully do very well at the top of this band; those who accept a wide catchment on a good per-visit rate frequently find the arithmetic disappointing. It is the single most practical piece of local knowledge in the occupation here.

For therapists who prefer hospital work to post-acute, the reliable route into the upper part of this band is board or specialty certification — certified hand therapist, neurological or paediatric specialty certification, assistive technology and seating credentials. The metro's rehabilitation and academic hospitals staff those caseloads deliberately and pay for them, and unlike internal seniority the credentials transfer between employers. Rehabilitation management is the other route, and it is the one that reaches the top of this published range most directly.