Do States Have Certification Requirements to Become an Occupational Therapist?

Ready to start your journey? is an advertising-supported site. Featured or trusted partner programs and all school search, finder, or match results are for schools that compensate us. This compensation does not influence our school rankings, resource guides, or other editorially-independent information published on this site.

Earning a master’s in occupational therapy, one of the highest paying master’s degrees, is an important step on the path to becoming an occupational therapist. You should also plan on putting in the work to attain professional credentials, such as mandatory licenses and optional specialty certifications, according to the United States Bureau of Labor Statistics (BLS). While licenses are awarded by the state in which you practice and certification is awarded by a professional organization like the American Occupational Therapy Association, occupational therapy students should know what to expect from the credentialing process. is an advertising-supported site. Featured or trusted partner programs and all school search, finder, or match results are for schools that compensate us. This compensation does not influence our school rankings, resource guides, or other editorially-independent information published on this site.

IMAGE SOURCE: Pixabay, public domain

Getting Licensed as an Occupational Therapist

Every state requires occupational therapists to earn a license, the BLS reported, but not every state necessarily has the same licensure requirements. All states in the U.S. use have some of the same licensing requirements, which the American Occupational Therapy Association refers to as “core” requirements. These include education – a master’s degree or doctoral degree accredited by the Accreditation Council for Occupational Therapy Education (ACOTE) – and fieldwork requirements.

Another requirement that is the same, no matter where in the United States you intend to pursue a license, is the certification exam you have to take. All states use a national exam for professional licensure in occupational therapy, according to the American Occupational Therapy Association. A passing score on the Occupational Therapist Registered (OTR) exam administered by the National Board for Certification in Occupational Therapy is required both as part of your state licensure application and to qualify you to use the professional title “Occupational Therapist, Registered,” according to the BLS.

The content of the OTR exam is divided into four sections. The topics of evaluation and assessment account for 25 percent of the exam. Questions about analysis and interpretation, which assess your ability to come up with conclusions that synthesize the needs and priorities of your patients, make up 23 percent of the test. The largest part of the test is intervention management, accounting for 37 percent of the exam content, and the smallest section, competency and practice management, makes up 15 percent of exam subject matter. In undertaking the OTR exam, you will have to answer 170 multiple-choice questions and complete three clinical simulation test items that include a written scenario accompanied by multiple questions or options.

Where do states differ in their licensure requirements? Although background checks are common for occupational therapists, as well as other healthcare professionals, states may have different processes and types of background checks that they require. Some states also ask occupational therapists pursuing licensure to complete a state-specific exam pertaining to the laws and regulations of that state, according to the American Occupational Therapy Association. States also set different continuing education requirements licensed occupational therapists must meet to keep their licenses in good standing.

Other requirements are more varied in nature. For example, in Arizona, you need to submit professional recommendations from two healthcare professionals. In Michigan, you’re required to take a training course on identifying victims of human trafficking.

Acquiring Advanced Certification in Occupational Therapy

The American Occupational Therapy Association offers advanced certification for occupational therapists who want to highlight their skills beyond what’s required for basic professional licensure. Historically, the American Occupational Therapy Association has offered certification in the board areas of physical rehabilitation, mental health, pediatrics and gerontology.

The professional organization also offered certification in specialty areas like low vision, environmental modification, driving and community mobility, occupational therapy in school systems and feeding, eating and swallowing. If you work in an occupational therapist role where you see all kinds of patients – young and old, in different settings and facing a variety of challenges caused by catastrophic injuries, chronic medical conditions and more – then you may have no need to specialize. If you wanted to seek voluntary certification, you would most likely opt for certification in the most general board area offered, physical rehabilitation.

Until recently, the method the American Occupational Therapy Association used to award advanced certification was a portfolio review, but the organization announced in 2019 that it would be switching to exam-based certifications. Pediatrics would be the first type of certification available by exam as of spring 2021, with physical rehabilitation following it in 2022.

Due to the gradual process of transitioning from a portfolio-based to an exam-based certification process, occupational therapists who wish to hold certification in other specialties may have to wait for the new exam to become available.

Additional Resources

How Easy Is It to Change State Certification in Occupational Therapy If I Move?

What Is the Difference Between an Occupational Therapy Assistant and an Occupational Therapy Aide?

What Is Involved in the Fieldwork Education Aspect of Becoming an Occupational Therapist?