North Carolina licenses occupational therapists and occupational therapy assistants through the North Carolina Board of Occupational Therapy. You need an accredited program with fieldwork and the NBCOT exam, and the board offers no temporary license: practice starts when the license is issued. 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.
North Carolina 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
No fingerprint step listed on the board's application page; check with the board
Same
Temporary license
None
None
OT Compact
Member, not accepting applications yet. North Carolina has enacted the OT Compact but has not opened privilege applications, so for now you need a full North Carolina license. (OT Compact, checked October 18, 2026)
North Carolina, step by step
North Carolina Board of Occupational Therapy
Request the online application and pay the $100 non-refundable fee by card. Do not send transcripts to the board.
NBCOT: you must have passed the NBCOT exam after an accredited OT or OTA program with fieldwork.
Jurisprudence exam: your login comes in the application email. It is 30 multiple-choice questions on the North Carolina OT Practice Act and board rules, drawn at random, and you must score 100%. It is free, each question links to the rule it tests, and your correct answers carry over when you retake it.
Wait for the license: the board has no temporary license, so you may not start work until it is issued. Application materials are good for 12 months.
Keep it: every license expires June 30 each year. A license issued January 1 to March 31 expires that June 30; one issued April 1 to December 31 expires the next June 30. North Carolina 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.