NBCOT Certification and State Licensure

Key points

• NBCOT certification and state licensure are two separate things. NBCOT states: certification is not the same as licensure.
• A degree alone does not grant a license, and admission to a program does not guarantee eligibility for certification.
• NBCOT eligibility for US-educated applicants rests on graduating from an ACOTE-accredited program.
• Licensure rules are state-specific. Check the state board where you plan to work.

What NBCOT is

NBCOT is the organisation that runs the national certification exams for occupational therapists and occupational therapy assistants. NBCOT states that OTR and COTA professionals have completed occupational therapy education and passed a national certification exam, and that only those who maintain Active in Good Standing status with NBCOT can use the OTR or COTA credential. NBCOT also states that its certification programs are accredited by the National Commission for Certifying Agencies; that refers to NBCOT’s programs, not to the degree programs applicants complete.

• OTR (Occupational Therapist Registered): for occupational therapists.
• COTA (Certified Occupational Therapy Assistant): for assistants.

Eligibility

NBCOT’s eligibility page states that U.S.-educated candidates must have graduated from an ACOTE-accredited program: an entry-level OT program for OTR candidates, and an OTA program for COTA candidates. Internationally educated applicants go through a separate process in which NBCOT checks whether their education and fieldwork are comparable to current U.S. standards.

The page we read does not list every condition, such as application steps, fees, conduct questions or timing. Read NBCOT’s current eligibility page and its exam handbook before you rely on any summary, including this one. Admission to a program does not guarantee that you will be eligible; you also have to graduate and meet NBCOT’s requirements.

Accreditation is covered in understanding ACOTE accreditation.

The exam

NBCOT publishes information on the exam content, study tools and testing accommodations on its site. We do not state pass rates, fees or question counts here, because we have not verified current figures. Use NBCOT’s own pages.

Certification is not licensure

NBCOT’s get-certified page states that certification is not the same as licensure and advises applicants to follow additional steps after the exam to obtain a license. The Bureau of Labor Statistics states that all states require licensure for occupational therapists, that requirements vary by state, and that at a minimum candidates must pass a qualifying exam. For OTAs, BLS states that a state-issued license is usually needed, which requires an accredited program, fieldwork and passing an exam, and that some states also require a background check.

NBCOT says that OTR and COTA professionals are also state-licensed professionals, but its page does not describe what licensure involves. That is the state’s role.

What state boards decide

State boards decide who may practise in their state and under what conditions. They may set requirements beyond NBCOT certification, such as an application, fees, a background check or jurisprudence questions; this varies, so we do not list them. NBCOT provides a page directing visitors to state licensing board contact information and a state regulatory portal.

Practical steps:

1. Before you enrol, identify the state or states where you may want to work.
2. Read the state board’s page for applicants and check that the program’s graduates are accepted.
3. Ask the board if you have prior convictions, health conditions or other questions that could affect licensure. Do this early.
4. If you plan to move later, check each state’s rules and whether it has a way to recognise licences from other states. We do not make claims about interstate compacts here.

Renewal

BLS states that therapists must complete continuing education hours to keep their state license and certification. NBCOT has a renewal process and handbook; read them for the current rules.

What does not substitute

A short course, a certificate, a bachelor’s degree in a related field or a PhD is not NBCOT certification and does not qualify someone as an OT or OTA. See certificates vs professional certification and OTD vs PhD.

How to use this site

Our states pages help you find programs by location. They do not describe licensing rules. For rules, go to the state board.

Sources

Checked 2026-11-03.

• NBCOT, get certified: https://www.nbcot.org/get-certified
• NBCOT, eligibility: https://www.nbcot.org/get-certified/eligibility
• NBCOT, what is an OTR or COTA professional: https://www.nbcot.org/occupational-therapy/what-is-an-otr-or-cota
• NBCOT, state boards: https://www.nbcot.org/state-boards
• BLS, Occupational Therapists: https://www.bls.gov/ooh/healthcare/occupational-therapists.htm
• BLS, Occupational Therapy Assistants and Aides: https://www.bls.gov/ooh/healthcare/occupational-therapy-assistants-and-aides.htm