States that Require or Don’t Require NBCOT Certification for Occupational Therapy License Renewal | Requirements List

Is NBCOT Renewal Required for Practice?

One question that I have and I get asked is whether it is required for you to renew your NBCOT certification in order for states to continue to renew your OT license and to practice as an occupational therapist.

For COTAs, there may be more state requirements compared to OTs as described in this post. Double check to make sure before letting it lapse if this is you.

For the OTR/L, the R is for registered and the L is for licensed. The R is a registered trademark owned by the NBCOT that certificates get to use and put after the name. The L is for someone who is licensed by at least one state in which they practice in. AFAIK, no one entity owns the L in license in terms of trademark?

So is NBCOT renewal required for continued occupational therapystate licensure? Answer: it depends on your state, but most do not require NBCOT continued certification.


For consumers of OT like clients patients, this means that if you just see OT/L, it does not mean that the occupational therapist is any less educated or competent than one who has the R in OTR/L.

You’ll be in good hands nonetheless because the OT practitioner still needs to meet state licensing requirements.

Other Professions

For other professions such as nursing, they use the registered nurse designation, RN. They don’t have like an “RNR/L”.

For PT, they just use their highest level of PT education followed by additional specialty certifications, like DPT for their doctorates. “Licensure is required in order to practice as a PT or work as a PTA in the United States. Licensure is managed by individual state regulatory boards” – same as OT, but they don’t even use the R or L.

According to the APTA, the official order of designation of letters after your PT’s name is:

  1. PT/PTA
  2. Highest earned physical therapy-related degree
  3. Other earned academic degree(s) – optional
  4. Specialist certification credentials in alphabetical order – optional
  5. Other credentials external to APTA – optional
  6. Other certification or professional honors (e.g., FAPTA) – optional

OT things more confusing, e.g., Name, MSOT, OTR/L, [other credentials] – likely because of the history and contention between NBCOT and AOTA.

Pros and Cons of NBCOT Renewal

Historically, NBCOT existed to certify OTs and to maintain a database of them.

All OT graduates are required to pay to take the NBCOT and then they renew and give them more money. Meanwhile, state and national (AOTA) membership is voluntary, but there are many reasons you should still be a member. Some OT schools encourage or require AOTA membership while you are a student, but many students likely choose not to renew after they graduate.

So NBCOT continues to get a continuous stream of money money while associations like the AOTA have relatively less for resources to go towards initiatives like OT advocacy. Personally, I am choosing not to renew my certification with the NBCOT. I think they have enough money already and would rather put it towards more advocacy for the profession such as state membership and the AOTA.

I also find the NBCOT renewal redundant – other states require you to continue with your competency by taking CEUs and completing related tasks. You submit the same requirements to both the NBCOT and your state. I don’t think this is efficient and it’s an added cost.

Why I Think OTPs Continue to Renew Their NBCOT

  1. One is it adds a letter to their alphabet of credentials – but I don’t think patients and the general public really care.
  2. Another is because everyone else is doing it and you see OTR/L everywhere but less of just OT/L. If you drop the R you would still include the slash so it’s written as “OT/L”. Personally, I think the slash is a very unnecessary convention, doesn’t look good, and a waste of characters and our efforts to remember to put it in our signature.
  3. The third is likely because it will allow them to practice in any state – so this is the main reason to renew your R. For me, if I was to continue to renew with the NBCOT, it would be if I was looking for peace of mind in the future if I would potentially practice in another state which required NBCOT certification. So if you are a traveler, it may make sense to renew your NBCOT. Or telehealth.
  4. Beneficial resources and CEUs – some OTPs have shared with me that they find the NBCOT useful. According to them, their website is easier to navigate than AOTA and they have just launched their Navigator CEU renewal platform. AOTA just refreshed their website so I think people are just getting used to the new layout. I think the AOTA is actually easier to use now and you can just use their search function to find what you want. I have tried the NBCOT Navigator but I was dissatisfied with it (I scored really low on it apparently) and I don’t think it is relevant for my real-world practice. In the time that I renewed my NBCOT, I did not go on the NBCOT website once compared to AOTA and actual journal articles in addition to MedBridge for CEUs.

2027 NBCOT Policy Changes

Some OTs have informed me that there may be a change with the NBCOT coming in 2027 in which if you lose your R, you won’t be able to “pay for your R back”, you’ll need to retest and retake the board exam. Note: I have not verified this information myself.

State NBCOT RENEWAL Requirements List

The following list is for license renewal, not initial licensing.

***Disclaimer: while I personally researched by either contacting or finding this information with every state, it would be impossible to keep this list updated. Please go straight to the source for the most up-to-date information. Again, this applies to primarily OTR, not sure about COTA, sorry. This very also time-consuming so please consider tipping me for my work – it would be much appreciated! 🙂

Do your own research for the most up-to-date information! This is just meant to be a starting point.

I am not responsible if you lose your R and need to pay or if you need to retake the NBCOT in order for you to be licensed because your specific state requires the NBCOT R.


Please contact me if any of the information is outdated or missing and you have verified it directly with the board or can forward me the webpage or policy. Thanks!

Alabama – No

Called and spoke directly with the OT State Board on 9/2022.

Alaska – ?

Emailed on 9/6/22.

Arizona – ?

Emailed on 9/6/22.

Arkansas – ?

Emailed on 9/6/22.

California – No

“NBCOT owns the trademarks “OCCUPATIONAL THERAPIST REGISTERED OTR” and “CERTIFIED OCCUPATIONAL THERAPY ASSISTANT COTA.” If you wish to use the trademarks, contact NBCOT.” [Source accessed 9/6/22]

This was the easiest to find of all the state OT boards. Kudos to California’s Board of OT for putting this in their FAQ page.

Colorado – No, but Deemed Status?

“OTAC is not able to provide legal advice but I can share our understanding of DORA regulations as it pertains to licensure renewal. NBCOT certification is not required unless you are claiming “deemed status.” If you do maintain NBCOT certification it meets DORA requirements for licensure renewal. If you do not have NBCOT certification then you will not be able to use the “R” in your legal signature and for renewal in Colorado you must follow and meet the continuing education program requirements outlined by DORA, which you can find on the DORA OT website.”

So it seems if you elect to not renew your NBCOT, you become deemed status. Couldn’t find what this technically means. I didn’t want to do any extra research so if anyone knows more, please let me know.

Connecticut – ?

“If applicable, official verification sent directly from each state licensing authority where a license or certification is or has ever been held. Most jurisdictions charge a fee for completion of the verification form. Please contact the jurisdiction for fee information.”

Emailed on 9/6/22 for clarification – awaiting response.

Delaware – No

Email response: “The NBCOT certificate is not required for license renewal. You should have provided all the required documents before the license is issued. For more information, see the Occupational Therapist Licensure page and License Renewal Page.”

Florida – No

NBCOT is not required for Florida OT license renewal. I spoke with someone from the state board on 9/6/22 over the phone.

Georgia – ?

Emailed on 9/6/22.

Hawaii – No

Email response: “NBCOT verification of certification is required for initial licensure, but not required for renewal at this time.”

Idaho – ?

Emailed on 9/6/22. They replied back and referred me to the document that I already looked at. Sent a follow-up question and awaiting a response. ¯\_(ツ)_/¯

Illinois – ?

Emailed on 9/6/22.

Indiana – ?

Emailed on 9/6/22.

Iowa – No

Emailed on 9/6/22. Got an e-mail response, “It is not.”

Kansas – ?

Emailed on 9/6/22.

Kentucky – ?

Emailed on 9/6/22. I got a reply, but the specialist asked many specific questions including my license number (which I provided) and for my NBCOT scores (too lazy to retrieve this). I gave up at this point. ¯\_(ツ)_/¯

Lousiana – No

“Licensure applicants – licensure applicants must be currently NBCOT certified.” [Source: website]

Emailed to confirm and awaiting a response. This is apparently for new applicants:

“Current NBCOT registration or certification is not a prerequisite to renewal of a license to practice as an occupational therapist or occupational therapy assistant.

However, licensure applicants must be currently NBCOT certified.”

Maine – No

Email response: “At this time the NBCOT certification is not required for license renewal”

Maryland – ?

Emailed for clarification.

Massachusetts – No

Email response: “It is not required to renew but we recommend that you keep the NBCOT current. CEUs are now required starting this month. See compliance of how many you need and the regulations below.”

Michigan – ?

Minnesota – No

Email response on 9/6/22: “MN statute does not include a license renewal requirement that mandates NBCOT certification. However, per NBCOT, if you allow your NBCOT certification to expire you are no longer able to use the R in OTR/L or the C in COTA/L.”

Mississippi – ?

Missouri – No

Email response: “Not with us but you might want to check with NBCOT”

Montana – No

Email response: “The NBCOT certificate is required for renewal, but it does not have to be active. We just need proof that you have had NBCOT.”

Nebraska – ?

Nevada – ?

Verification of NBCOT Certification – Current certification status must be submitted with your application. Acceptable documentation:
✓ on-line verification printout from NBCOT; or
✓ request written verification from NBCOT to be sent directly to the Board.

Source – may be outdated

New Hampshire – No

Email response: “The NBCOT is not required to renew.”

New Jersey – ?

New Mexico – ?

New York – No

New York State licenses occupational therapists and authorizes occupational therapy assistants. Since an occupational therapist must pass the national certification examination to become licensed, almost all licensed occupational therapists hold the designation “OTR.” It is common practice for these individuals to sign their names using the title “OTR/L,” where the “R” refers to national certification and the “L” refers to state licensure. However, there is no requirement in New York State that licensed occupational therapists be registered nationally. Licensed occupational therapists who are not nationally registered would use the title “OT/L.”

Source – Thank you NY for making this information easy to find!

North Carolina – ?

To complete your online renewal you will need:

  • your North Carolina OT or OTA license number;
  • the last four digits of your social security number or your previous renewal password;
    documentation showing proof of completion of a minimum of 15 continuing competence activity (CCA) points, including at least one CCA point in ethics;
  • if this is your first renewal, you are not required to provide CCA points (unless you have been notified by the Board that you are required to submit CCA points);
  • a valid MasterCard, Visa or Discover card with expiration date, security code and complete billing address.

…did not see any mention of NBCOT in this list.


North Dakota – ?

What you need to complete the renewal:

  • To log in: Your last name, your ND license number, and the last four digits of your Social Security Number.
  • A credit card or debit card to pay the renewal fee.
    Note: If your renewal went through, a receipt should appear on the screen. If you do not get a receipt, call the Board office to confirm the renewal.

Continuing Education
Please have your CEU information ready prior to beginning the online renewal. There will be a page within the form for the CEU information to be added and the certificates to be uploaded.

CE Information Format
Continuing Education Hours – ONLY use Number Digits – Example 2, 3, 4, etc.
DO NOT use words such as hours or two.
Date format must use a mm/dd/yyyy format.

Jurisprudence Exam
During the online renewal application, you will be required to take the Jurisprudence Exam. The exam is over Law and Rules governing OT Practice in ND.

So the answer is no as I did not see any mention of the NBCOT on this page.

Ohio – No

Email response: “No, NBCOT certification is not a requirement for renewal of your state license.” –Ohio Occupational Therapy, Physical Therapy, and Athletic Trainers Board

Oklahoma – ?

NBCOT was not mentioned in the renewal webpages. Contact the board for verification.


Oregon – No

Email response: no, it is not required by the Oregon OT Licensing Board that you are NBCOT certified. Some employers or insurers may require it.

In Oregon however, we have tied our CE rule to current NBCOT certification, if you are current when you renew, you automatically meet the state CE requirement. Here is the rule:

339-020-0010 CE Requirements for Current Licensees

(1) All current licensees shall obtain a minimum of 30 points of CE from Board approved categories during the two years immediately preceding the date of the license renewal;

(2) Maintenance of current NBCOT Certification (National Board of Certification in Occupational Therapy) may be used to satisfy the requirements for CE under subsection (1) of this rule but may not be used to satisfy the cultural competency CE requirements of OAR 339-020-0025 or the pain management CE requirements of OAR 339-020-0015.

Pennsylvania – No

See document: Renewal Guide PDF

Rhode Island – ?

South Carolina – Yes

“As a condition of license renewal, a licensee must complete satisfactorily sixteen hours of continuing education per biennium as defined in regulation and must submit proof of completion on a form approved by the board and must be certified and in good standing with NBCOT or other board-approved certification program.”

South Dakota – ?

I did not see any mention of the NBCOT on their renewal or CEU page. Contact the board for verification.

Tennessee – No

Email response: “No it is not required to renew your TN license.”

Texas – No

Email response: “The Texas Board does not require you to have your certification with NBCOT.”

Utah – No

Email response: “No, you do not. You are required to complete 24 hours of continuing education to renew.”

Vermont – No

Email response: “NBCOT certification is not required, however we will accept a copy of your current certification in lieu of certificates of completion showing you have completed 20 CE’s during the biennial renewal period.”

Virginia – No

Email response: “No it is not required for VA”

Washington – No

Email response: “No. It is not required for renewal.”

West Virginia – ?

No mention of NBCOT on the renewal page.

Wisconsin – ?

Wyoming – ?

No mention of NBCOT on the renewal page.


This was a fun research project for me (but got tedious towards the end for the last one-third of the states).

Most states specifically do not require NBCOT certification for continued state license renewal. Unfortunately, this information is often not listed on the state board websites. I am still awaiting a reply from the majority of the states. So far, I’ve discovered that South Carolina requires NBCOT certification for license renewal.