Working & Studying in the United States

What are the education requirements?

Effective July 31, 2013, internationally educated occupational therapists must meet one of the following minimum criteria established by the National Board for Certification in Occupational Therapy (NBCOT) to be considered eligible for the initial certification examination, which is required for practice:

  1. Completion of an Entry-Level Bachelor's Degree in Occupational Therapy from a government authorized and/or WFOT approved college or university occupational therapy educational program AND a Post Professional Masters Degree in Occupational Therapy** OR
  2. Completion of an Entry-Level Master's Degree in Occupational Therapy from a government authorized and/or WFOT approved college or university occupational therapy educational program**

**In addition to the master's degree requirement in occupational therapy, applicants must complete NBCOT's Occupational Therapist Eligibility Determination (OTED) review to determine comparability to U.S. accreditation occupational therapy educational standards/competencies.

What are the regulatory requirements?

  • Qualifying to take the certification exam given by the National Board for Certification in Occupational Therapy (NBCOT) and passing it
  • Passing tests of English language competency, if applicable
  • Attaining a visa certification
  • Meeting state regulatory requirements, including attaining a license in those states where it is required

Certification Exam

The U.S. organization that administers the initial certification exam required to practice in the United States is the National Board for Certification in Occupational Therapy (NBCOT). NBCOT and AOTA are completely separate organizations.

Requirements for applying for the exam include completing NBCOT's Occupational Therapist Eligibility Determination (OTED) application.

Internationally trained therapists may not function as occupational therapy assistants (OTAs), as OTAs must graduate from accredited OTA programs and pass the NBCOT exam for OTAs in order to practice. The roles of the OTA and therapist are complimentary, but they are differentiated and are not interchangeable.

English Language Tests

English is the official language of the United States, and all candidates must demonstrate English-language proficiency by passing a test, such as the Test of English as a Foreign Language (TOEFL). Graduates of occupational therapy programs in Australia, Canada (except Quebec), Ireland, New Zealand, and the United Kingdom are currently exempt. See NBCOT's web site for information.


The U.S. Department of Homeland Security issues visas to foreign nationals wishing to work in the United States. In most cases, this will be a category H1B temporary work visa. For further details about Health Care Worker Certification, visit the U.S. Department of Homeland Security website.

You must get a visa certificate before applying for a visa. Two organizations are authorized by the U.S. Department of Homeland Security to provide visa certification. They are:

State Regulatory Requirements

Employers require occupational therapy practitioners to meet state regulatory requirements. The first step in this process is becoming certified by NBCOT by meeting its requirements and passing necessary exams.

Therapists must also meet the regulatory requirements of a state of jurisdiction in order to practice. In addition to passing the NBCOT initial certification examination, 50 states, the District of Columbia, Guam, and Puerto Rico regulate occupational therapy services. Most of these jurisdictions require continuing education to maintain a license. AOTA provides numerous continuing education opportunities, including online courses, self-paced clinical courses, continuing education articles published in OT Practice, and an Annual Conference along with links to more than 250 additional approved providers across the United States.

Each state in the United States has a regulatory board and a professional association that provides resources regarding practice and continuing education. Contact the state regulatory board to determine the particular requirements of that state for initial and continuing ability to practice occupational therapy.

Employment Resources

Employment is available in many different areas of occupational therapy practice. Job advertisements and career information are published online by AOTA on OTJoblink.

Employment advertisements are also published in AOTA's practice magazine, OT Practice.

You should make inquiries about employment to the specific employer in the job advertisement. Salaries, benefits, and specifics of employment (e.g., experience required, days and hours of employment, travel required, etc.) vary and are determined by the employer. AOTA does not make placement arrangements.

For further information contact:

American Occupational Therapy Association (AOTA)
4720 Montgomery Lane, Suite 200
Bethesda, MD 20814

Phone: (301) 652-2682
Fax: (301) 652-7711