Becoming an occupational therapist requires a graduate degree from an accredited program, a passing score on a national certification exam, and a state license. The full process typically takes six to seven years after high school, including an undergraduate degree and a two- to three-year graduate program. Here’s what each step involves.
Undergraduate Preparation
There is no single required undergraduate major for occupational therapy. Programs set their own prerequisite courses, but most expect a similar foundation in science and behavioral health. A typical list includes human anatomy with lab, human physiology with lab, statistics, introductory psychology, abnormal psychology, lifespan development, introductory sociology or anthropology, and medical terminology.
Most programs require a minimum cumulative GPA of 3.0 and a grade of C or higher in every prerequisite course. That said, minimums are rarely competitive. Admitted students generally have much higher grades, and a cumulative GPA of 3.6 or above is a more realistic target if you want a strong application. Because prerequisite lists vary from school to school, check the specific requirements of every program you plan to apply to early in your undergraduate career.
Master’s vs. Doctoral Degree
Entry into the profession requires either a Master of Occupational Therapy (MOT) or a Doctor of Occupational Therapy (OTD) from a program accredited by the Accreditation Council for Occupational Therapy Education (ACOTE). Both degrees qualify you to sit for the certification exam and practice as a registered occupational therapist. The American Occupational Therapy Association has confirmed there are currently no plans to require a doctoral degree only, so master’s programs remain a fully valid path.
An MOT typically takes two to three years and focuses on clinical skills, patient care, and preparing you for entry-level roles in healthcare, education, and rehabilitation. An OTD takes roughly two and a half to three years and covers all the same foundational coursework but adds training in leadership, healthcare policy, advocacy, advanced research methods, and a doctoral capstone project. The capstone often leads to specialization in a particular area of practice or program development. If you’re interested in leadership, policy work, or academic research, the OTD provides a more direct route. For clinical practice, either degree gets you to the same starting line.
Fieldwork and Clinical Hours
Every accredited program includes substantial supervised clinical training called Level II fieldwork. For master’s and doctoral students, ACOTE requires a minimum of 24 weeks of full-time fieldwork completed across more than one practice area, in up to four different settings. This fieldwork must be finished within 24 months of completing your classroom coursework.
Part-time fieldwork is allowed as long as you work at least 50% of a full-time equivalent at the site. The total hours that count as full-time depend on each facility’s personnel policies, so the exact hour count varies. Fieldwork placements span settings like hospitals, schools, outpatient rehab clinics, and community mental health programs, giving you a broad view of where occupational therapists practice.
National Certification Exam
After graduating, you must pass the certification exam administered by the National Board for Certification in Occupational Therapy (NBCOT). Passing earns you the OTR (Occupational Therapist Registered) credential. To be eligible, you need to have graduated from an ACOTE-accredited program. There is no way to sit for the exam without completing an accredited degree.
If you earned your occupational therapy degree outside the United States, you must first go through the Occupational Therapist Eligibility Determination (OTED) process. This requires at minimum an entry-level master’s degree in occupational therapy (or a bachelor’s in OT combined with a graduate degree in OT or a related field), plus at least 960 hours of fieldwork from the degree-granting institution. You’ll need to submit official transcripts, course syllabi, a program director form, verification of any existing OT license or registration, and a professional practice history form. The OTED application fee is $850, and approval is valid for seven years, meaning you must take and pass the exam within that window.
State Licensure
Passing the NBCOT exam alone does not authorize you to practice. Every state regulates occupational therapy independently, and you need a license from the state where you plan to work. Common requirements beyond the NBCOT credential include a state or federal criminal background check, an official final transcript from your OT program, and in some states, passage of a jurisprudence exam covering that state’s specific laws and regulations for occupational therapy practice. Requirements vary enough that you should check with the licensing board in your state before assuming your NBCOT certification is all you need.
Maintaining Your Certification
Your NBCOT certification is not permanent. To keep it active, you must complete at least 36 continuing education units during each renewal cycle. These units can come from courses, conferences, publications, mentoring, and other professional development activities. If you let your certification lapse, you may need to retake the exam or complete additional requirements to reinstate it, depending on how long it has been.
The Occupational Therapy Assistant Path
If you’re interested in the field but not ready to commit to six or seven years of education, becoming a Certified Occupational Therapy Assistant (COTA) is a shorter route. OTAs need a two-year associate degree from an ACOTE-accredited program, followed by a minimum of 16 weeks of full-time Level II fieldwork across more than one practice area in up to three settings. After graduating, OTAs take a separate NBCOT exam to earn the COTA credential.
OTAs work under the supervision of a registered occupational therapist. They carry out treatment plans, help patients practice daily activities, and document progress, but they do not independently evaluate patients or design treatment programs. The role is a practical entry point into the profession, and many COTAs later pursue a graduate degree to become full occupational therapists.
Physical and Cognitive Demands
Occupational therapy programs require students to meet technical standards that reflect the physical reality of the job. You’ll need gross motor ability to move safely through clinical environments, enough strength and balance to help transfer patients (for example, moving someone from a bed to a wheelchair), and fine motor skills for tasks like splint making, manipulating adaptive equipment, and detailed documentation.
Sensory skills matter too. You need to accurately observe human movement and behavior, distinguish between safe and unsafe environments, and recognize when a therapeutic approach is or isn’t working. Cognitively, the work demands the ability to conduct assessments, compute and interpret test scores, synthesize information from multiple sources, and adjust your clinical reasoning in real time. Programs also expect professional judgment: responding well to feedback, relating appropriately to patients and supervisors, and demonstrating reliability in attendance and time management.