Occupational Therapy Assistant Salary in Houston, TX 2026,
$81,340 Median | BLS + Market Data

Houston occupational therapy assistants earn a BLS median of $81,340/yr, or $39.11 an hour, across the Houston-Pasadena-The Woodlands metro, with a published band from $61,890 to $94,070. That is 12.5% above the US median for the occupation, with no state income tax applied. BLS counts 900 OTAs in the metro.

No — the metro median is level with the Texas statewide figure. Demand for occupational therapy assistants is strong across the whole state, including smaller markets where skilled nursing facilities struggle to staff therapy departments, which flattens the geographic gradient. Among peer metros Houston sits below San Diego at $82,680 and just above Austin at $81,500, Dallas at $81,170, San Antonio at $79,240 and Atlanta at $78,180.

Skilled nursing and home health. Both are reimbursed per episode under Medicare, both rely heavily on assistants to deliver treatment under a therapist's plan of care, and both compete for a workforce of only about 900 people in the whole metro. Inpatient rehabilitation follows. Paediatric clinics and school district practice sit at the bottom of this band, funded by education and state programme budgets rather than by medical reimbursement.

Through the Texas Board of Occupational Therapy Examiners, which operates under the Executive Council of Physical Therapy and Occupational Therapy Examiners. The route requires an associate degree from an accredited occupational therapy assistant programme, completion of supervised fieldwork, passage of the NBCOT assistant certification examination, and a Texas jurisprudence assessment. Practice is always under the supervision of a licensed occupational therapist. Licensure is statewide; Houston issues nothing separately.

It is one of the better ones available in this metro. A median 12.5% above the national figure, no state income tax, moderate housing costs and projected growth of 19.2% together make a strong case for a two-year associate degree. The limitations are honest ones: the band tops out at $94,070, the work is physically demanding, and advancing beyond the ceiling means becoming an occupational therapist, which requires a master's or doctoral degree and effectively restarting the education.

900 occupational therapy assistants for a metro of this size is a very small number, and it is the key to the wage. Post-acute providers across the region depend on assistants to deliver the volume of therapy that Medicare episodes fund, and there are not enough of them. Training capacity is limited, the programmes are selective, and each graduate has multiple employers competing for them. That is the mechanism behind a 12.5% premium over the national figure for a credential that takes two years to obtain.

An occupational therapy assistant works under a licensed occupational therapist, who evaluates the patient, writes the plan of care and reassesses progress. That relationship determines caseload, autonomy and how the working day is structured, and its quality varies enormously between employers. In busy skilled nursing settings assistants may work with limited direct oversight within a defined plan; in hospital departments supervision is closer. Assistants moving between posts in this metro should ask specifically how supervision and reassessment are organised, because it is the largest non-financial variable in the role.

Two forces are behind the projection. The population is ageing, which raises demand for rehabilitation after stroke, fracture, joint replacement and cognitive decline. And providers facing occupational therapist shortages and cost pressure are delegating more treatment delivery to assistants under supervision, which is both permitted and economically rational. In a fast-growing region like this one, the first factor is amplified. The roughly 130 openings a year pro-rated here, against a workforce of 900, describes a market that is genuinely expanding rather than merely replacing.