Becoming an occupational therapist requires a master’s or doctoral degree from an accredited program, at least 24 weeks of supervised clinical fieldwork, and a passing score on a national certification exam. The full path from undergraduate studies to licensed practice typically takes six to seven years, and the career reward is strong: occupational therapists earn a median salary of $98,340 per year, with employment projected to grow 14% over the next decade.
Undergraduate Preparation
You don’t need a specific bachelor’s degree to apply to occupational therapy (OT) school, but you do need to complete a set of prerequisite courses during your undergraduate years. These typically include two semesters of human anatomy and physiology with a lab, a statistics course, and abnormal psychology. Programs also require coursework in human development and behavior, social systems, and reasoning or critical thinking.
Some schools add a unique requirement: a hands-on “occupation” experience. At UNC, for example, applicants must try something that’s genuinely new to them in a structured, social learning environment for at least six weeks. It has to result in a product or performance. Think pottery, welding, or a musical instrument, not a foreign language class. This doesn’t need to be taken for college credit, but it does need to be documented.
There’s no universal minimum GPA, but most programs are competitive. A strong science foundation matters more than your major. Students come from backgrounds in psychology, biology, kinesiology, public health, and liberal arts.
Applying to OT Programs
Most OT programs use the Occupational Therapy Centralized Application Service (OTCAS), a single portal where you submit your materials and then designate which schools receive them. The OTCAS fee is $150 for your first program and $65 for each additional one. Individual schools may charge their own supplemental application fee on top of that.
A typical application includes your transcripts, a resume, short essay responses, and three letters of recommendation. At least one letter usually needs to come from a practicing occupational therapist or occupational therapy assistant, so building professional connections through observation hours or volunteering is essential before you apply. Application systems generally open in midsummer, with deadlines falling in October or November for programs starting the following year. Interviews happen in January or February, and admission offers go out shortly after.
Master’s vs. Doctoral Degree
The entry-level degree for occupational therapists is either a master’s or a clinical doctorate. Both lead to the same credential and the same license. A master’s program (often called an MOT, MA, or MS depending on the university) takes about two to three years after your bachelor’s degree. A Doctor of Occupational Therapy (OTD) program runs three to four years.
The main difference is the doctoral capstone: OTD students complete an additional 14-week capstone experience and a culminating project, which allows deeper focus on a specific area like research, leadership, or clinical practice. Some students also enter combined bachelor’s-to-master’s programs that accept you before you finish your undergraduate degree and award both degrees in sequence. Either degree level qualifies you to sit for the national certification exam and practice as a registered occupational therapist.
Clinical Fieldwork Requirements
All OT students complete two levels of clinical fieldwork built into their program. Level I fieldwork introduces you to real clinical settings while you’re still taking courses. There’s no national minimum for Level I hours; each program sets its own requirements.
Level II fieldwork is the intensive clinical portion. You’ll complete a minimum of 24 weeks of full-time work in practice settings like hospitals, schools, rehabilitation centers, or outpatient clinics. This can be done full-time or part-time, but never less than half-time as defined by the site. Level II fieldwork is where you apply what you’ve learned under the supervision of a licensed OT, gradually taking on more independent responsibility with clients.
Certification and Licensing
After graduating, your next step is the national certification exam administered by the National Board for Certification in Occupational Therapy (NBCOT). You must have graduated from an accredited OT program to be eligible. Passing this exam earns you the credential OTR, which stands for Occupational Therapist Registered.
Certification alone doesn’t let you practice. Every state requires its own license. State licensing requirements vary but commonly include a criminal background check and, in some states, a jurisprudence exam covering that state’s specific OT laws and regulations. Once licensed, you can begin practicing in your state. If you trained outside the United States, you’ll need to go through a separate eligibility determination process with NBCOT, which costs $850 and involves submitting transcripts, syllabi, and documentation proving your education is comparable to U.S. standards.
Occupational Therapist vs. OT Assistant
If the full graduate-level path feels like more than you’re ready for, occupational therapy assistants (OTAs) offer a faster entry point into the field. OTAs need a two-year associate degree from an accredited program and pass a separate NBCOT exam to earn the Certified Occupational Therapy Assistant (COTA) credential.
The scope of practice is the key difference. Occupational therapists independently evaluate clients, create treatment plans, and sign off on progress assessments. OTAs carry out those treatment plans and report progress back to the supervising OT, but they don’t work independently. They assist with exercises, help clients use adaptive equipment, and support evaluations through testing and observation. If you start as an OTA and later want to become a full occupational therapist, you’ll need to complete a master’s or doctoral program, as there’s no bridge exam that skips the degree.
Specialization Options
Once you’re practicing, you can pursue advanced board certifications through AOTA to formalize expertise in a specific population. The main specialty areas include pediatrics (working with children, youth, and families), physical rehabilitation (across hospital and outpatient rehab settings), and gerontology (older adults). These are exam-based certifications that signal advanced knowledge to employers and clients. They aren’t required to practice in these areas, but they distinguish you professionally.
Many OTs also develop informal specializations through their work settings. Hand therapy, mental health, driving rehabilitation, and school-based practice are all common niches that OTs grow into through experience and continuing education, even without a formal board certification.
Job Outlook and Earning Potential
Occupational therapy is one of the faster-growing healthcare professions. The Bureau of Labor Statistics projects 14% employment growth from 2024 to 2034, well above the average for all occupations. An aging population needing rehabilitation services and growing recognition of OT’s role in mental health and pediatric care are driving demand.
The median annual salary of $98,340 reflects mid-career earnings across all settings. Pay varies by geography, setting, and specialization. OTs in acute care hospitals and home health tend to earn more than those in school systems, though school-based positions offer predictable schedules and summers aligned with the academic calendar. Travel OT positions, where you take short-term contracts in understaffed areas, often pay significantly above the median.