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OT Licensure

Occupational therapists and occupational therapy assistants must obtain a license to deliver occupational therapy services in all 50 states, including the District of Columbia, Puerto Rico, and Guam. This license bestows upon you the legal authority to practice occupational therapy within the specific state of licensure. 

It’s important to distinguish between your occupational therapy license and the certification achieved through the National Board for Certification in Occupational Therapy (NBCOT) exam. The license is the legal permission to practice, while certification is earned through successfully passing the NBCOT examination.

OT Licensure by State

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Core Licensing Requirements

OT Licensing Requirements (1)

Key Licensing Criteria

Navigating the process of obtaining a state license for practicing occupational therapy might seem overwhelming initially, but with informed preparation, it becomes more manageable. The infographic above outlines the general process and highlights the “core” licensing requirements: 
  1. Graduate from an ACOTE®-accredited OT or OTA educational program. 
  2. Fulfill fieldwork requirements. 
  3. Apply for and successfully pass the NBCOT® Certification Examination. Visit the NBCOT website for additional information on the examination process, including Score Transfers and Eligibility Confirmation Notices. You’ll need to create an account to access NBCOT services and resources. 
  4. Submit an initial license application and pay the requisite fee for each state or jurisdiction where you plan to practice or hold a license. 
Keep in mind that each state overseeing occupational therapy may have additional requirements beyond these basics. Ensure you’re well-informed about specific state demands, which may include: 
  • Completion of a state and/or federal criminal background check. 
  • Successful completion of an exam on the state’s laws and regulations (sometimes referred to as a state law or state jurisprudence exam). 
  • Submission of an official final transcript from your OT or OTA educational program. 
It’s crucial to be aware of individual state requirements for licensure. These criteria are established in state law and regulations, with changes requiring a lengthy process and exceptions made only under specific or extraordinary circumstances.

Supervision Overview

In every state and territory regulating occupational therapy, an occupational therapy assistant requires supervision from an occupational therapist. An occupational therapy aide can be supervised by either an occupational therapist or an occupational therapy assistant. Additionally, students pursuing licensure as occupational therapists or occupational therapy assistants must undergo supervision during fieldwork or while acquiring the necessary experience for a doctorate degree.

Supervision Process

The supervision process is a collaborative effort where the supervisor and supervisee work together to ensure that the supervision provided not only aligns with the supervisee’s experience and fosters professional development but also guarantees the delivery of optimal care and services to clients. Determining the nature of supervision involves considering factors such as the supervisee’s experience, practice setting, client load, complexity of client needs, and adherence to state requirements.

Variability in State Requirements 

State requirements for supervision exhibit variability. Some states afford flexibility for the supervisor and supervisee to collaboratively devise a supervision plan that benefits all parties. Conversely, in other states, laws or regulations explicitly specify the frequency and nature of supervision. Whether in the role of a supervisor or supervisee, understanding your responsibilities and role within the supervisory relationship is essential. 
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State License Renewal

Maintaining an active state license is imperative for providing occupational therapy services in the United States. Failing to renew your license not only jeopardizes your employment but also entails costly and time-consuming efforts to reinstate it. It is your responsibility to familiarize yourself with the steps required to keep your license current. Although renewal requirements vary among states, the following are general guidelines: 
  1. Complete and submit a license renewal application to your state licensing entity. 
  2. Pay the prescribed renewal fee. 
  3. Ensure compliance with mandatory continuing education or continuing competency hours, even though proof may not be immediately requested during renewal. 
Additional requirements might include undergoing a criminal background check, participating in an ethics course, or taking an exam on your state’s laws and regulations (referred to as a law or jurisprudence exam). 

Continuing Education Requirements 

Meeting continuing education or continuing competency requirements is crucial for sustaining your license. These activities, mandated by most state licensing agencies, vary in nature and are essential for the license renewal process. 

It is your responsibility to stay informed about your state’s specific requirements. Our offerings provide numerous opportunities to stay abreast of the latest research, interventions, and trends in the OT profession, with some options available at no cost. 

Significance of License Maintenance 

Maintaining your license is not only vital for professional practice but also ensures the continuity of professional liability coverage and the ability to bill insurance. Practicing with an expired license can lead to criminal charges or fines if discovered by your state licensing agency. Once your license lapses, all states mandate the cessation of occupational therapy services. 

Timely License Renewal

While the possibility of reclaiming a lapsed license exists, some states offer grace periods or late renewal processes with minimal penalties. Delaying renewal, however, escalates the costs and time involved in resuming practice. To safeguard your professional standing, it is strongly advisable to renew your license on schedule. 


The National Board for Certification in Occupational Therapy (NBCOT) oversees the national certification examination for occupational therapists and occupational therapy assistants. Explore the certification criteria further by visiting the NBCOT website. State licensure regulations define the prerequisites for acquiring a license and engaging in occupational therapy practice. Obtaining initial certification through NBCOT stands as a fundamental component of licensure requirements within the occupational therapy field. Stay informed and prepared for your occupational therapy journey by understanding and meeting these crucial standards. 

Applying for a license has no state limit, providing flexibility in your choices. While the foundational licensure criteria are consistent, additional requirements may differ. Conduct thorough research on the unique requirements in each state before applying, and create a well-organized document checklist, including the application, transcript, letters of recommendation, and a criminal background check. This ensures a smooth application process tailored to each state's specific needs. 

In most cases, yes you can apply for an OT license at any time. However, you must meet all requirements established in law or regulation by the state or jurisdiction in which you are applying in order to receive the license. States may have specific requirements for individuals who, despite completing their education and passing the exam, choose not to pursue licensure. 

Yes, you will need to renew your OT licenses and the time frame and requirements can vary from state to state. Most will require renewal every two years. Failure to renew your license results in the inability to practice as an occupational therapy practitioner. Continuing to work without a valid license can lead to significant legal consequences. 

Renewal prerequisites differ among states. Typically, the process involves submitting a renewal application, paying a fee, and fulfilling specific continuing education or continuing competency obligations.

Each state determines the cost therefore the costs vary.  

Continuing education or continuing competency encompasses a series of tasks essential for license renewal. The purpose of these activities is to stay abreast of developments in the occupational therapy field, elevate your professional practice, and showcase your clinical expertise and proficiency. Examples of such activities may involve volunteering for occupational therapy services, engaging in research, mentoring fellow practitioners, supervising fieldwork or doctoral students, or contributing to occupational therapy journal articles. Each state maintains its own catalog of approved continuing education or continuing competency activities. 

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