CurrentOT, Occupational therapistOTA, Occupational therapy assistant
Occupational therapist
What it is
Commonly works on
- Hand and upper limb
- Daily living skills
- Cognition and sensory processing
- Home and work adaptation
Typical settings
- Hospitals
- Schools
- Outpatient and hand clinics
- Home health
Occupational therapy was founded as a profession in March 1917, when six people met in Clifton Springs, New York, to form the National Society for the Promotion of Occupational Therapy, the body now known as the American Occupational Therapy Association.
Occupational therapy centers on the activities of daily life, and AOTA's own summary is that it can be provided wherever daily activities occur. Services are provided by licensed occupational therapists and occupational therapy assistants in homes, schools, community settings such as shelters and free clinics, hospitals, nursing homes, outpatient clinics and primary care offices. Practitioners also work as consultants in areas such as driving and community mobility, health promotion and design.
Practice acts set its limits, and some state them plainly: Texas's act, for example, says occupational therapy does not include diagnosis.
Entry is through an accredited master's or doctoral program; ACOTE lists programs at both levels. Graduates sit the NBCOT examination to earn the OTR credential, which NBCOT stresses is not the same as a license; a state license is required in every state.
Sources
- Reed KL. 2026. Susan Cox Johnson: Focus on Educational Standards and Curriculum. Occupational Therapy in Health Care. (official site)
- What is occupational therapy? (official site)
- Texas Occupations Code Chapter 454, Occupational Therapists (Section 454.006) (official site)
- Find a School (official site)
- Get Certified (official site)
A general description of the profession. It does not say what you may do under your license; for that, see the scope statuses below and your state board.
How it is regulated
National certification, then a state credential
A national body sets the entry standard and certifies people who meet it. States then regulate practice on top of that, by license, certification or registration depending on the state. The two layers are separate obligations, each with its own renewal.
- OTR
- National certification, then a state credential
- Around 6–7 years from starting undergraduate study
- NBCOT
Licensure
Two layers. NBCOT certification is national and carries its own renewal requirement; the state license authorizes practice and carries a separate one.
OT Compact
Enacted, not yet issuing privilegesWidely enacted, only partly live. Around thirty states have passed it; a much smaller number have finished implementation and are issuing privileges.
Scope at a glance
- Not typicalOccupational therapy laws generally do not include spinal manipulation, and several, including Maryland's and Nebraska's, expressly exclude it.
- Varies by stateOccupational therapy laws rarely name joint mobilization, so whether it is allowed usually depends on your state board. Illinois rules list it with training requirements, and Nebraska's law excludes only grade V and thrust techniques.
- Varies by stateOccupational therapy laws rarely name instrument-assisted soft tissue work; where a rule does, as in Illinois, it is a modality that needs added training, so whether it is allowed depends on your state board.
- Varies by stateOccupational therapy laws rarely name cupping; where a rule does, as in Illinois, it is a modality that needs added training, so whether it is allowed depends on your state board.
- Varies by stateA few states now let occupational therapists dry needle with extra training, while others say their law does not allow it.
- Varies by stateOccupational therapy practice acts rarely mention imaging, and we found none that lets occupational therapists order it. Some acts, such as Michigan's and Texas's, exclude medical diagnosis from occupational therapy, so whether it is allowed depends on your state board.
- Within scopeOccupational therapy laws commonly include exercise, generally framed as supporting daily activities and function.
- Varies by stateWe found no occupational therapy practice act that names blood flow restriction; whether an occupational therapist may use it depends on your state board's reading of its modality and competence rules.
- Varies by stateOccupational therapists may help people recover from concussion, and at least one state lets them clear young athletes to return to play, but most laws we read do not name them.
- Within scopeOccupational therapists use elastic taping as part of a broader treatment plan; practice acts rarely name it.
- Within scopeOccupational therapists may use electrical stimulation as part of occupation-focused treatment, but many states set conditions first, such as added training or board approval, and at least one limits it to the shoulder, arm and hand.
- Within scopeOccupational therapists may use therapeutic ultrasound as part of occupation-focused treatment, but many states set conditions first, such as added training or board approval, and at least one limits it to the shoulder, arm and hand.
- Varies by stateOccupational therapists address dizziness and balance problems as they affect daily activities, and AOTA has a 2025 position statement on OT's role, but OT practice acts are written around daily function and do not name vestibular rehabilitation or repositioning maneuvers, so how far an occupational therapist may go depends on the state board's reading.
- Within scopeOccupational therapists use the pool to work on function and daily activities, though states that regulate water-based physical agents may require added training for some water treatments.
- Within scopeOccupational therapists use soft tissue techniques as part of occupation-focused care; many state laws name manual therapy, and some add training rules.
- Varies by stateOccupational therapists may use mechanical traction in some states, often after added modality training, while many OT laws do not mention mechanical modalities at all.
- Within scopeOccupational therapists may use low-level laser as a physical agent within occupation-based treatment, though states often require added training or board approval first.
- Varies by stateOccupational therapy acts and AOTA's modalities statement do not name shockwave therapy, so OT use depends on how the state board reads its physical agent rules.
- Varies by stateOccupational therapy laws do not mention ultrasound imaging, and some exclude diagnosis, so whether an occupational therapist may use it as an assessment or biofeedback tool depends on the state board's reading.
- Varies by stateOccupational therapists can help athletes return to school and daily life, but few youth concussion laws let them sign return-to-play clearance; Iowa's does.
- Varies by stateWhether an occupational therapist may treat without a referral depends on the state: some now allow it for a limited number of visits or days, while others require a referral to treat a medical condition.
- Within scopeOccupational therapists may provide care by telehealth; the occupational therapy licensure compact names telehealth as one of its aims and treats care as happening where the client is located.
- Varies by stateSome states let occupational therapists purchase, store and administer prescribed topical medications, including by iontophoresis, but never controlled substances; elsewhere the law is silent.
- Not typicalOccupational therapy laws exclude diagnosis, and none we read authorizes ordering laboratory tests.
Bodies and guidance
Bodies
- WHOInternational organizationWorld Health OrganizationThe United Nations agency for global public health; issues evidence-based guidelines, including on low back pain.
- AOTAProfessional associationAmerican Occupational Therapy AssociationThe national professional association for occupational therapy.
- NBCOTCertifying bodyNational Board for Certification in Occupational TherapyCertifies occupational therapists and assistants through its national exam.
- ACOTEProgram accreditorAccreditation Council for Occupational Therapy EducationAccredits occupational therapy and assistant programs.
- WFOTInternational organizationWorld Federation of Occupational TherapistsThe international body for occupational therapy, representing occupational therapists worldwide and setting standards for the profession.
- OT CompactInterstate licensure compactOccupational Therapy Licensure CompactAn interstate compact for occupational therapists and assistants; a privilege to practice can be used only in member states that have opened applications, not merely enacted the law.
Guidance
CurrentOT, Occupational therapistOTA, Occupational therapy assistant
Physical agent, mechanical, and instrument-assisted modalities in occupational therapy practice
CurrentAT, Athletic trainerPT, Physical therapistOT, Occupational therapistDC, Chiropractor
Consensus statement on concussion in sport: the 6th International Conference on Concussion in Sport–Amsterdam, October 2022
CurrentDC, ChiropractorPT, Physical therapistOT, Occupational therapist
WHO guideline for non-surgical management of chronic primary low back pain in adults in primary and community care settings
CurrentPT, Physical therapistOT, Occupational therapist
Package of interventions for rehabilitation: module 2: musculoskeletal conditions
CurrentOT, Occupational therapistOTA, Occupational therapy assistant
Standards of practice for occupational therapy
CurrentPT, Physical therapistOT, Occupational therapist
Rehabilitation Competency Framework
CurrentOT, Occupational therapistOTA, Occupational therapy assistant
Occupational therapy practice framework: domain and process, fourth edition
SupersededOT, Occupational therapistOTA, Occupational therapy assistant
AOTA 2020 Occupational Therapy Code of Ethics
CurrentPT, Physical therapistOT, Occupational therapist
Guidelines on the management of chronic pain in children
SupersededOT, Occupational therapistOTA, Occupational therapy assistant
Occupational therapy practice framework: domain and process (3rd edition)
Overlap with other professions
How to become an occupational therapist
- Step 1
Earn a bachelor's degree with the program prerequisites
- Step 2
Complete an ACOTE-accredited master's or doctoral program
- Step 3
Pass the NBCOT certification examination
- Step 4
Apply for the state license
Where to get licensed
Each step in full, with the board for every state and the compacts that apply.
Get licensed as an occupational therapistCareer path
Education routes, settings and how the profession is changing.