All the states in the United States require successful
completion of NBCOT's occupational therapy certification
examination. In other words, you can practice or work in the
United States only if you pass the Board Examination.
The National Board for Certification in Occupational Therapy
(NBCOT) certifies that both US and internationally educated
occupational therapists meet its criteria for Occupational
Therapist Registered (OTR) Exam. NBCOT does not certify
internationally educated candidates for Certified Occupational
Therapy Assistant Exam (COTA).
Passing the NBCOT certification examination does NOT
automatically entitle you to work in America. You must first meet
all the requirements of the state regulatory entity in order to
legally practice occupational therapy.
To become eligible to take the OTR certification examination,
internationally-educated occupational therapists must meet NBCOT
eligibility requirements and undergo prescreening based on the
status of their occupational therapy educational programs. NBCOT
eligibility requirements include:
Graduation (a bachelor's degree, diploma, or certificate) from an
acceptable entry-level occupational therapy program.
Supervised Experience: A certain number of hours of fieldwork or practical
English Language Proficiency:
Passage of three tests of English language proficiency,
including the Test of English as a Foreign Language (TOEFL),
Test of Written English (TWE), and Test of Spoken English (TSE).
The English language requirements do not apply to graduates of
educational programs in
Canada (excluding Quebec Province),
New Zealand and
After all required documents and payments have been received,
your application will be reviewed to determine if you meet the
standards for eligibility to take the Examination. You will be
sent a letter with the results of the review (approval, denial,
request for additional documentation).
If approved, you will
be eligible to apply for the certification examination either
online or with a paper application. The certification
examination will be on-demand, year long testing. Upon
approval to take the certification examination, a candidate will
receive a letter authorizing them to apply for the certification
Upon approval to
take the Examination, the NBCOT can provide you with a
Nonimmigrant Visa Letter for immigration and/or employment,
which states your professional education equivalency to that of
a U.S. educated occupational therapist, and approval to apply
for the certification examination.
Upon successful completion of the examination, you may request
an application to obtain a Visa Credential Verification
Certificate, which is required by INS interim regulations for
occupational therapists seeking permanent work-related visas.
State Regulatory Boards
Prior to working in the US as an occupational therapist, it is
essential that you meet the requirements of the state regulatory
board in the state in which you wish to work. Most, but not all
states, have laws governing the employment qualifications of
occupational therapists. Most, but not all of these state
boards, will allow you to work in the state if you have been
certified as an OTR by the NBCOT. However, it is essential that
you receive a license or permit from the state board before you
start to work in that state. Each state in the United States has
a regulatory board and a professional association that provides
resources regarding practice and continuing education.
Employers require occupational therapy practitioners to meet
state regulatory requirements. The first step in this process is
becoming certified by NBCOT by meeting their requirements and
passing necessary exams. Therapists must also meet the
regulatory requirements of a state of jurisdiction in order to
Inquiries concerning employment must be made directly to the
prospective employer. Employment contracts will vary among
states and institutions; thus, salaries, position levels,
benefits, etc. are negotiable between you and your prospective