How to Practice Occupational Therapy in the United States as a Foreigner (Internationally Educated)

A common question that I get is from people overseas interested in practicing occupational therapy in the United States. Currently, occupational therapy assistants who are internationally educated are not recognized for certification and practice in the United States, only occupational therapists. These are the steps for how to practice as an occupational therapist in the United States for those who are internationally educated.

How to Practice OT in the United States

In the US, to practice as an occupational therapy practitioner (OTP), there are two main requirements. The first is to pass the OT board exam that is certified by the NBCOT (National Board for Certification in Occupational Therapy). The NBCOT is an entirely separate organization than the AOTA, which is the American Occupational Therapy Association. The AOTA is a completely voluntary professional association, whereas the NBCOT proctors the NBCOT Exam, a mandatory step needed for those wishing to practice OT in the United States, either citizens or foreigners. I still highly recommend becoming an AOTA member as it is a professional healthcare association with numerous benefits!

The second step is to become licensed in the state you wish to practice in. For example, if you are looking to work in Texas, then you will need to apply for licensure with the OT board in Texas. If you decide to move to California, then you would have to then apply (for a second licensure) with California. Each state in the US has it’s own board of OT, which then has it’s own set of requirements and process for licensure.

OT Board Exam and Degree Requirements for Foreigners

Foreigners looking to become eligible to take the NBCOT Exam must first apply for the Occupational Therapist Eligibility Determination process (OTED). According to the NBCOT, “the OTED process will determine if your completed education, including 960 hours of fieldwork that must be attained through the degree-granting institution, at minimum, at a bachelor’s degree level, meets the eligibility requirements to apply for the OTR certification exam. Education and fieldwork must be deemed comparable to current U.S. entry-level educational standards.”

This may be a little confusing as they a mention minimum bachelor’s degree and in the US, entry-level occupational therapists are required to have a master’s degree. However, the NBCOT lists in their education requirements for the OTED that one of the following must be met:

  • An entry-level master’s degree in occupational therapy, or
  • A bachelor’s degree in occupational therapy with a post-professional master’s or doctoral degree in occupational therapy, or
  • A bachelor’s degree in occupational therapy with a master’s degree in a related field.

So to summarize so far, foreigners must take and pass the NBCOT. And to be eligible for the NBCOT as a foreigner, you must go through the OTED process. And for the OTED educational requirement, you need a master’s degree either in OT or a related field. There are additional requirements (see below), but these are the most important ones as it pertains to an educational degree and are the biggest barrier to practice for people.

Once approved for the OTED process, foreigners are eligible to apply to take the OTR (registered) exam and are valid to take it for 7 years from the date of approval. This means after you qualify as a foreigner to sit for the OTR by the NBCOT, you have 7 years to study and take it. By the way, I offer a free NBCOT Exam Prep Course to help students study and pass the NBCOT Exam. Also, earning a post-professional master’s/doctoral degree in occupational therapy in the U.S. does NOT guarantee OTED approval. OTED approvals are based on the educational comparability review of your combined education.

Degree Mandate

I have been getting conflicting information regarding the possibility of OT and COTA programs moving to a higher degree requirement in 2027. However, upon further research, the ACOTE website says there is currently no mandate.

Additional OTED Requirements

  • National Government Recognition documentation (if applicable)
  • Official final transcript(s)
  • Verification of Academic Credential Form (if applicable)
  • Course syllabi reflecting content taught at the time you completed the coursework
  • Program Director Form
  • Verification of OT License, Registration, or Certification Form
  • Professional Practice History Form

*I am not entirely clear on what these specific items mean, so please refer to the NBCOT website for the Internationally Educated for more information. New applicants looking to complete the OTED application can apply online as a new applicant.


  1. There is an $850 USD application fee for the OTED.
  2. The NBCOT OTR Exam costs $515 USD.
  3. The fee to reapply is $385 USD.
  4. After you become certified by the NBCOT, you would apply with the state you wish you work for, which has its own set of fees and requirements.

That is beyond the scope of this as each state has specific requirements and the costs can vary. Here are some helpful links for you to get started in your process of becoming an occupational therapist in the US. Good luck!


State Board Licensure Process

To find the state boards you wish to become licensed in step 2, google [state] occupational therapy state board, e.g., ‘Texas occupational therapy state board’. Look on their website for the licensure process for foreigners, e.g., Google: texas occupational therapy state board foreigner’. Keep in mind that every state has its own unique requirements and this may be easier or more difficult than another state. Those looking to become travelers will need to be licensed by each state.

Example for California state licensure

“Occupational therapists trained outside of the United States are required to complete the educational and supervised fieldwork requirements set forth in the Occupational Therapy Practice Act (OTPA) section 2570.6 and successfully complete the entry-level certification examination administered by NBCOT. There are no occupational therapy assistant programs recognized by the World Federation of Occupational Therapists. Only US graduates of occupational therapy assistant programs can take the NBCOT certification examination. Additionally, by law, before the Board can issue a license, the applicant must have a US Social Security Number.”
Please directly contact the NBCOT and each respective state board for more information. I am not an expert in this process, just passing the general information along. If you contact me, I will just refer you to the links below for the NBCOT OTED and each state then has its own requirements that would be impossible for me to remember. 🙂
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