Becoming an occupational therapist requires a graduate degree (master’s or doctorate), supervised clinical fieldwork, a national certification exam, and a state license. The full path from undergraduate studies to practicing takes roughly six to seven years, though the timeline depends on whether you pursue a master’s or doctoral program and how you structure your prerequisites.
Start With a Bachelor’s Degree
There is no single required undergraduate major for occupational therapy school. Students commonly major in psychology, biology, kinesiology, or health sciences, but admissions committees care more about completing specific prerequisite courses than the name on your diploma. Most OT graduate programs require coursework in human anatomy, physiology, psychology (often both introductory and abnormal), statistics, sociology or anthropology, and sometimes medical terminology or physics. Requirements vary by program, so check the admissions pages of schools you’re considering early in your undergraduate career.
Beyond coursework, nearly all programs expect you to log observation hours in occupational therapy settings before applying. These hours give you direct exposure to what OTs actually do day to day and help admissions committees gauge your commitment to the field. The number of required hours varies, but many programs ask for somewhere between 20 and 80 hours across different practice settings, such as a hospital, a pediatric clinic, or a skilled nursing facility. Reaching out to local OT departments or rehabilitation centers is the most straightforward way to arrange these.
Earn a Master’s or Doctoral Degree in OT
Entry into the profession requires either a Master of Occupational Therapy (MOT or MS in OT) or a Doctorate of Occupational Therapy (OTD). Both degree levels prepare you for entry-level practice, and both must be accredited by the Accreditation Council for Occupational Therapy Education (ACOTE). There is currently no requirement to earn a doctorate, according to the American Occupational Therapy Association.
A master’s program typically takes two to two and a half years of full-time study. A doctoral program runs about three to three and a half years, with the additional time devoted to a capstone project involving advanced research or specialized clinical experience. Your choice between the two depends on your career goals. If you’re interested in research, academic teaching, or advanced specialization, a doctorate can open doors. For clinical practice, a master’s is fully sufficient and gets you working sooner.
Graduate coursework covers neuroscience, human development across the lifespan, biomechanics, therapeutic techniques, mental health interventions, assistive technology, and evidence-based practice. Programs blend classroom learning with hands-on lab work from the start, so you’ll practice splinting, adaptive equipment fitting, and treatment planning well before your formal clinical rotations begin.
Complete Clinical Fieldwork
Fieldwork is the bridge between classroom knowledge and real patient care. ACOTE divides it into two levels.
Level I fieldwork is integrated throughout your coursework and introduces you to clinical environments. You’ll observe and assist under supervision, getting a feel for different populations and settings.
Level II fieldwork is far more intensive. Master’s and doctoral students must complete a minimum of 24 weeks of full-time Level II fieldwork across no more than four different settings. These placements must reflect more than one practice area, meaning you’ll rotate through distinct environments like acute care, outpatient rehabilitation, school-based therapy, or mental health. If full-time placement isn’t feasible, programs can arrange part-time fieldwork at no less than 50% of the site’s full-time equivalent, though this extends the total duration.
During Level II, you gradually take on a full caseload under the guidance of a licensed OT. By the end, you’re expected to function at entry-level competency: evaluating patients, writing treatment plans, documenting progress, and collaborating with other healthcare providers. These rotations are also where many new graduates make connections that lead to their first job offers.
Pass the National Certification Exam
After graduating from an accredited program, you need to pass the certification exam administered by the National Board for Certification in Occupational Therapy (NBCOT). Passing this exam earns you the credential OTR (Occupational Therapist Registered), which is required for licensure in every state.
The exam costs $540. If you need to retake it, the fee drops to $430. A paper application option is available for $595, though it takes longer to process. To apply, you create an account on NBCOT’s website, complete the online application, and have your school send an official final transcript showing your degree title and conferral date. If your school hasn’t released transcripts yet but you’ve met all graduation requirements, your program can submit a Degree Verification Form, which lets you sit for the exam up to six months before your anticipated graduation date within the same calendar year. Your results won’t be released until NBCOT receives the official transcript.
The exam itself is a multiple-choice, computer-based test covering clinical simulation scenarios. Most candidates spend four to eight weeks studying with a combination of review courses, practice exams, and textbook review. Pass rates for first-time test takers from accredited programs are generally high, but the exam is rigorous enough that dedicated preparation matters.
Get Your State License
Passing the NBCOT exam doesn’t automatically allow you to practice. You also need a license from the state where you plan to work. Every state regulates occupational therapy, and while the core requirements overlap (an accredited degree, passing the NBCOT exam, and an application), additional requirements vary.
Some states require a criminal background check at both the state and federal level. Others require you to pass a jurisprudence exam, which tests your knowledge of that state’s specific occupational therapy laws and regulations. You may also need to submit an official transcript directly from your program, letters of recommendation, or proof of liability insurance.
If you plan to work in multiple states or relocate after graduation, research each state’s requirements before you apply. Processing times range from a few weeks to a couple of months, so submitting your application early can prevent gaps between graduation and your start date.
What Occupational Therapists Earn
Occupational therapists earn a median annual salary in the range of $95,000 to $100,000, with entry-level positions starting lower and experienced OTs in high-demand specialties or leadership roles earning well above that. Settings like home health and travel OT positions often pay premiums compared to hospitals or school systems, though they come with different lifestyle trade-offs. Geographic location also plays a significant role, as areas with higher costs of living or provider shortages tend to offer stronger compensation.
Where Occupational Therapists Work
One of the appeals of this career is the variety of work settings. Hospitals and rehabilitation centers employ large numbers of OTs, but the profession extends well beyond those walls. You might work in a school system helping children with developmental disabilities access their education, in an outpatient clinic treating hand injuries, in a skilled nursing facility helping older adults regain independence, or in a mental health facility addressing daily living skills.
Some OTs specialize further through practice certifications in areas like hand therapy, pediatrics, driving rehabilitation, or low vision. Others move into non-clinical roles such as ergonomic consulting, assistive technology design, or program management. The foundational degree and license are the same regardless of where you end up, which gives you flexibility to shift your focus as your interests evolve throughout your career.
Timeline at a Glance
- Undergraduate degree: 4 years, including prerequisite courses and observation hours
- Graduate OT program: 2 to 3.5 years depending on master’s vs. doctorate
- NBCOT exam and state licensure: 1 to 3 months after graduation
- Total: roughly 6 to 8 years from starting college to treating your first patient independently