A Certified Occupational Therapist Assistant (COTA) is a skilled healthcare professional who works under the supervision of an Occupational Therapist. COTAs help clients of all ages who have physical, developmental, or emotional challenges to develop, recover, and maintain the skills needed for daily living and meaningful participation in life. Entering this profession requires following a structured roadmap that includes education, fieldwork, national certification, and state licensure.
Complete an Accredited Associate Degree Program
The initial step to becoming a COTA involves completing an associate-level degree program specifically for Occupational Therapy Assistants. Candidates typically pursue an Associate of Applied Science (AAS) or an Associate of Science (AS) degree from an accredited community college or technical school. The program must hold accreditation from the Accreditation Council for Occupational Therapy Education (ACOTE), which ensures the curriculum meets national standards.
This academic phase usually takes about two years to complete. Core coursework provides foundational knowledge in subjects like anatomy, physiology, kinesiology, and human development. Students also take specialized classes in occupational therapy principles and therapeutic techniques. Only graduates of an ACOTE-accredited program are eligible to sit for the national certification examination.
Fulfilling Clinical Fieldwork Experience Requirements
Classroom instruction is followed by a mandatory practical component known as fieldwork, which integrates academic knowledge with real-world application. Fieldwork is structured into two distinct levels designed to build professional competence under experienced clinicians. Level I Fieldwork is an introductory, often part-time experience focusing on observation and gaining an initial understanding of the practitioner’s role.
Level II Fieldwork is the immersive, in-depth clinical experience required for graduation and eligibility for the certification exam. COTA students must complete a minimum of 16 weeks of full-time Level II fieldwork, typically divided into two separate placements. This intensive experience requires students to apply therapeutic reasoning, deliver interventions, and manage a client caseload under direct supervision. The goal of Level II is to develop the skills necessary to function as a competent, entry-level practitioner.
Passing the National Certification Examination
After completing academic and fieldwork requirements, candidates must pass the national certification examination administered by the National Board for Certification in Occupational Therapy (NBCOT). This computer-based exam evaluates a candidate’s knowledge and skills for safe and effective entry-level practice. The COTA exam consists of approximately 170 multiple-choice questions, typically completed within a three- to four-hour testing window.
The exam content is organized into three major domains reflecting professional responsibilities. These domains are: Collaborate and Gather Information, Select and Implement Interventions, and Uphold Professional Standards and Responsibilities. Candidates must achieve a scaled score of 450 or higher to pass, which grants the nationally recognized title of Certified Occupational Therapy Assistant (COTA).
Obtaining State Licensure to Practice
Achieving national certification from the NBCOT provides the COTA credential, but it does not automatically grant the legal right to practice. Nearly all states require a separate license or authorization from a state regulatory board before an individual can legally work as an occupational therapy assistant. This state licensure process is administrative and legal.
Requirements for state licensure vary by location but universally require proof of successful completion of an ACOTE-accredited program and passing the NBCOT exam. Additional requirements may include:
Submitting to a state and federal criminal background check.
Providing official academic transcripts.
Paying a licensure fee.
Passing a jurisprudence exam, which tests knowledge of state practice laws.
Understanding the Certified Occupational Therapist Assistant Role and Career Outlook
The COTA’s primary function is to implement the treatment plan developed by the supervising Occupational Therapist, working directly with clients to meet their goals. Daily duties include teaching adaptive techniques, guiding therapeutic exercises, training clients on specialized equipment, and documenting progress. The work requires strong communication and observation skills to adjust activities and report back to the supervising therapist.
COTAs find employment across a wide variety of settings, including hospitals, skilled nursing facilities, schools, outpatient clinics, and home health agencies. The job market outlook is strong, driven by the aging population and increased need for rehabilitation services. The median annual salary typically falls in the mid-$60,000s, with potential for higher earnings based on geographic location and experience.
Maintaining Certification and Continuing Education
The professional requirements for a COTA continue after initial licensure to maintain the right to practice. The national NBCOT certification must be renewed every three years to retain the COTA credential. Renewal requires the accumulation of at least 36 Professional Development Units (PDUs) within the three-year cycle, earned through activities like continuing education courses, professional presentations, or mentoring.
State licensure also requires periodic renewal, usually every one to two years, and mandates the completion of Continuing Education Units (CEUs). State CEU requirements are separate from the NBCOT PDU requirements, meaning practitioners must track both to remain in good standing. Failure to meet these competency requirements can result in the loss of the COTA credential or the state license.