State Regulation Overview

NBCOT works in partnership with state regulatory entities to protect the public interest by ensuring that occupational therapy practitioners meet a high national certification standard. All state regulatory entities recognize NBCOT's occupational therapy certification examinations, and our Certification Examination Validation Committee (CEVC) has one state regulatory member who serves as a liaison between the CEVC and state regulatory entities.

How We Work with State Regulatory Agencies

NBCOT and State Regulatory Agencies from across the country work cooperatively to exchange and update information about the field of occupational therapy. The agencies also report disciplinary actions against certified professionals and request that NBCOT publish the actions. Regulators also attend NBCOT's Annual State Regulatory Conference and receive NBCOT publications. See OT State Regulatory Board Contact List.

How Is State Regulation and National Certification Different

A state license grants an occupational therapy practitioner permission to practice in that jurisdiction. State regulations vary.

NBCOT certification is nationwide recognition that an occupational therapy practitioner has met a national standard of professional achievement beyond state licensure. For U.S.-educated occupational therapy practitioners, this means graduating from an Accreditation Council for Occupational Therapy Education (ACOTE) accredited degree education program, completing required Level II fieldwork experience, and passing the NBCOT certification examination. Every third year, practitioners must complete certification renewal requirements in order to maintain use of the individual’s Occupational Therapist Registered (OTR®) or Certified Occupational Therapist Assistant (COTA®) credential.

Certification requirements for internationally-educated occupational therapy practitioners include graduation from a post-baccalaureate occupational therapy program recognized by the World Federation of Occupational Therapy (WFOT) at the time of graduation, or a baccalaureate degree in occupational therapy from a WFOT-approved program, plus additional education reviewed by NBCOT and approved as being comparable to a U.S. post-baccalaureate degree in occupational therapy. Candidates educated outside the United States also must have completed at least 1,000 hours of fieldwork and passed the English language competency examinations. (Graduates of occupational therapy programs in Australia, Canada (except Quebec), Ireland, New Zealand, and the United Kingdom are currently exempt from the English test requirements.) Finally, internationally-educated occupational therapy practitioners must pass the NBCOT certification examination, and every third year, complete certification renewal requirements in order to maintain use of the OTR credential.

Certification Renewal Program Complements State Licensure

In developing its Certification Renewal Program, NBCOT carefully reviewed state regulatory requirements. We found that at the time of renewal, fewer than half of the jurisdictions ask behavior-related questions and only nine ask the same questions.

One jurisdiction has a title protection law that does not contain any form of disciplinary action, reporting, or continued competency. Two others do not regulate occupational therapy assistants at all, and one licenses occupational therapists, but only registers occupational therapy assistants (not requiring passage of an exam).

There are no uniform licensure or continuing competence requirements among the states. While 40 jurisdictions request a defined number of continuing education units or contact hours, the remaining jurisdictions have virtually no requirements beyond completing an application and paying a fee to that jurisdiction or regulatory entity.

NBCOT certification process is a national model that states are encouraged to embrace. Following successful completion of the initial certification examination, ongoing professional development is required every three years. This national certification standard supplements state regulatory requirements. Current certification is evidence that an occupational therapy practitioner maintains a national standard, which gives employers, patients and clients confidence in professional competency.

NBCOT has and will continue to consult with state regulators in designing the Certification Renewal Program so that it is not redundant. The Certification Renewal Program does nothing to change the responsibilities for disciplinary action among the states, NBCOT, or AOTA. All responsibilities remain the same.

State Regulatory Supervision Requirements for Occupational Therapy Assistants

Examination for State-Reactivation Purposes

Professional Conduct

NBCOT Candidate/Certificant Code of Conduct