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How to get your occupational therapist license

The national steps first, then what your state adds. Every state uses the same certification exam, the NBCOT OTR, with the same passing score; the license itself comes from your state's board, and it is a separate application.

Practice for the OTR examFree, our own questions, scenario sets and a score report by task

The steps

  1. Finish an ACOTE-accredited degree and your fieldwork

    You need an entry-level master's or doctoral degree in occupational therapy from a program accredited by ACOTE (the Accreditation Council for Occupational Therapy Education), including the program's Level II fieldwork. Educated outside the U.S.? NBCOT's Occupational Therapist Eligibility Determination (OTED) process reviews your education first.

  2. Apply to NBCOT for the exam

    Create one MyNBCOT account (a duplicate costs $35), apply online and pay the $540 application fee ($595 on paper). You also answer character review questions and agree to the Code of Conduct. Add your free Score Transfer to your state board, and a free Eligibility Confirmation Notice if your state issues temporary permits, at the time you apply; later they cost $35 each. The application is good for 90 days, so apply when you plan to test soon.

  3. Get your Authorization to Test and book Pearson VUE

    Once NBCOT approves you, the Authorization to Test (ATT) letter arrives by email within about three business days. It is active for 90 days; schedule at a Pearson VUE center inside that window. Changing an appointment less than 48 hours out, or missing it, costs a $115 ATT reissue.

  4. Take the exam

    180 questions in 4 hours: single-answer multiple choice plus multi-select scenario sets (an opening scene, then four questions where you pick the three best of six). Breaks are allowed but the clock keeps running. Bring ID whose name matches your application exactly.

  5. Get your score

    Scores run from 300 to 600; 450 passes. Results post to your MyNBCOT account on NBCOT's scoring calendar. Pass, and you are an OTR with a digital certificate; your Score Transfer goes to your state. If you don't pass, you get a feedback report by domain.

  6. Apply for your state license

    NBCOT certification is not a license. Apply to your state's OT board, pay its fee and send what it asks for (transcripts, fingerprints or a background check, the score transfer). Some states add a jurisprudence exam or a laws-and-rules course. Some issue a limited or temporary permit while you wait for your score; check your state's rules before you work under one.

  7. Keep it current, and moving later

    NBCOT certification renews every 3 years with 36 units of professional development; your state license renews on the state's own schedule. Moving? The OT Licensure Compact lets a licensed OT in a member state apply for a privilege to practice in other member states, which are opening applications on their own timelines.

Occupational therapy assistant? The steps are the same with an ACOTE-accredited OT assistant program and its fieldwork, and the NBCOT COTA exam: 190 questions in 4 hours, single-answer multiple choice plus stand-alone pick-3-of-6 questions (no scenario sets), the same $540 application and the same 450 passing score. Your state then licenses or regulates you as an OT assistant, and you practice under an OT's supervision as your state's practice act sets out. Practice for the COTA exam.

The numbers

ItemOTR examCOTA exam
Questions180: multiple choice plus multi-select scenario sets (4 items each, pick 3 of 6)190: multiple choice plus stand-alone multi-select items (pick 3 of 6)
Time4 hours (about 4 h 45 min appointment)4 hours
Passing score450 on a 300-600 scale, same in every state450 on a 300-600 scale
Fees$540 online application ($430 to retake), plus your state's feesSame as the OTR
RetakesWait 30 days before attempts 2-4, 60 days before 5-7, 90 days after thatSame as the OTR
Where and whenPearson VUE test centers, any open date in your 90-day ATT windowSame as the OTR

If you don't pass

Use the feedback report: it shows how you did in each of the four domains. Reapply after the waiting period with a new application ($430 online). Our score report does the same thing for free on practice questions: it lists the outline tasks you miss. If you hold a temporary state permit, call your state board right away; the permit may end with a failing score.

Your state

Every state and DC, each checked against that state's own board pages and rules:

Links