Missouri licenses occupational therapists and occupational therapy assistants through the Missouri Board of Occupational Therapy in the Division of Professional Registration. New graduates can work on a limited permit while they wait for the NBCOT exam. Everything below comes from the board's own pages and rules, checked October 18, 2026. Fees and rules change, so confirm on the linked pages before you pay.
Check with your board. OT Ticket is a study aid, not clinical or legal guidance. Not affiliated with, endorsed by or connected to the National Board for Certification in Occupational Therapy (NBCOT), AOTA, ACOTE, the OT Compact Commission or any state board; NBCOT, OTR and COTA are their marks, used here only to name the exam.
Missouri at a glance
Occupational therapist (OT)
OT assistant (OTA)
Exam
NBCOT OTR exam (180 questions, 4 hours), $540 to NBCOT
NBCOT COTA exam (190 questions, 4 hours), $540 to NBCOT
Board fees
$30 application (20 CSR 2205-1.050)
$10
Law exam
Board jurisprudence exam (sent with your application or limited permit)
Same
Background check
Fingerprinting, required for every application since June 30, 2012
Same
Limited permit
$10; recent ACOTE graduates, valid to 8 weeks after NBCOT eligibility ends
$10
OT Compact
Member, not accepting applications yet. Missouri has enacted the OT Compact but has not opened privilege applications, so for now you need a full Missouri license. (OT Compact, checked October 18, 2026)
Missouri, step by step
Missouri Board of Occupational Therapy (Division of Professional Registration)
Apply on the board's Application for Licensure with the non-refundable fee: $30 for an OT, $10 for an OTA. Fingerprinting is required.
Jurisprudence exam: complete the board's jurisprudence exam; it goes in with your application (the limited permit is processed once the board has it).
Limited permit (optional): for recent ACOTE graduates. Apply any time before the NBCOT exam ($10), but it is issued only after NBCOT sends the board its Confirmation of Examination Registration and Eligibility to Examine. It lasts until 8 weeks after your eligibility expires. Pass, and it extends 60 days while you file the Addendum to Original Application with the license fee ($30 OT, $10 OTA). Fail, and you may renew it once for a second attempt; fail again and it is void.
NBCOT scores: pay NBCOT to send your initial score report to the Missouri board when you register; NBCOT also releases scores to the board twice a month.
Keep it: renewal is $30 (OT) or $10 (OTA) every two years. Missouri has enacted the OT Compact but is not accepting privilege applications yet.
Every state licenses occupational therapists and OT assistants on NBCOT certification: an ACOTE-accredited degree with its Level II fieldwork, then NBCOT's exam (the OTR exam for OTs, 180 questions in 4 hours; the COTA exam for OT assistants, 190 questions in 4 hours; 450 on a 300-600 scale passes; $540 to apply online). NBCOT certification is not a license: you apply to your state board separately, and NBCOT sends the board your score (the Score Transfer is free if you add it when you apply for the exam, $35 later). The full walk-through: How to get your OT license.