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Occupational therapists

Occupational therapist jobs abroad: UK, Ireland, EU, US

Occupational therapy is regulated in all five countries MedicSail covers. The UK and Ireland assess your degree and fieldwork on paper, Germany and the Netherlands check equivalence and language, and the USA reviews your education through NBCOT's OTED process before the OTR exam.

Overview

To work as an occupational therapist abroad you need HCPC registration in the UK, CORU registration in Ireland, recognition from the state authority in Germany, BIG registration in the Netherlands, and in the USA NBCOT eligibility, the OTR exam and a state licence.

Only the US route has a mandatory written exam; elsewhere gaps lead to a test of competence, an aptitude test or an adaptation period. Occupational therapists help people of all ages to do the everyday things that matter to them after illness, injury or disability, or when their development is delayed. They assess function, plan treatment and adapt tasks and environments, in hospitals, rehabilitation and mental health services, schools, social care and the community. The title is protected in all five countries MedicSail covers.

This page is for occupational therapists who qualified in one country and want to work in the UK, Ireland, Germany, the Netherlands or the USA. It compares who regulates OTs in each country, what they ask for, language levels, exams, timelines and official pay figures.

The UK (HCPC) and Ireland (CORU) both assess your qualification against their standards of proficiency, on paper. If they find gaps, the HCPC may offer a test of competence and CORU sets a compensation measure, either an adaptation period or an aptitude test. UK-trained OTs can use CORU's fast-track pathway, which needs fewer documents.

Germany and the Netherlands run state recognition procedures and add a language requirement. In Germany, Ergotherapeut is regulated under federal law and you need German at B2. In the Netherlands, ergotherapeut is an article 34 profession, so you need CIBG recognition but no BIG registration, plus Dutch at B2 and English reading at B1.

The USA is the most education-focused route. If your OT degree is not from a US-accredited programme, NBCOT first reviews your education and fieldwork through its OTED process, which requires at least a master's level of education in most cases and 960 fieldwork hours. Only then can you sit the OTR exam, and every state also requires a licence.

Qualifications

Minimum

A qualification in occupational therapy that gave you the right to practise in the country where you trained, with documented practice placement (fieldwork) hours. CORU asks for one year of practice within the last ten years if OT is not regulated where you qualified. For NBCOT OTED, at least a bachelor's in OT combined with a master's or doctorate (or an entry-level master's in OT) and 960 hours of fieldwork.

Preferred

A bachelor's or master's degree in occupational therapy covering both physical and mental health practice, with placement hours broken down by setting. This makes the HCPC course information form, CORU's standards mapping and the German and Dutch equivalence checks more straightforward. UK BSc and MSc OT graduates can use CORU's fast-track pathway.

Experience

No regulator sets a fixed number of years, but experience is evidence. The HCPC and CORU consider it when deciding whether you meet their standards, the German and Dutch authorities take it into account in equivalence assessments, and NBCOT asks for a professional practice history form as part of OTED.

Country by country

United Kingdom: HCPC

Occupational therapist (protected title)

Requirements
An online international application with a course information form from your university including practice placement hours, an occupational therapist standards mapping document, references and the non-refundable £678.38 scrutiny fee. Two OT assessors decide on paper.
Exams
No written exam. Assessors may offer a test of competence, a structured professional discussion, usually online, to be completed within 12 months.
English
IELTS 7.0 overall with no element below 6.5, TOEFL iBT at the HCPC's scores, or OET Occupational Therapy 1400 with no element below 300. Exempt if you qualified where English is the predominant language.
Timeline
The HCPC says about 3 months from a complete application to a first decision, then about 3 months of verification.
Good to know
Registration fee £370.02 after acceptance. Many UK OT posts are in local authority social services; check the employer can sponsor a Health and Care Worker visa.
Occupational therapists in the United Kingdom: full guide
About the HCPCWorking in the United Kingdom

Ireland: CORU

Occupational therapist (protected since 31 March 2017)

Requirements
Recognition of your international qualification by the Occupational Therapists Registration Board against the CORU standards of proficiency, then a separate registration application with Garda vetting, a statutory declaration and police clearance. CORU's guidance and leaflet state a €510 application fee.
Exams
None as standard. If CORU finds substantial differences, a period of adaptation in Ireland of up to 3 years or an aptitude test (€500, offered within six months).
English
IELTS Academic 7.0 with no element below 6.5, OET Occupational Therapy grade B (350) in three components and at least C+ (300) in one, or Cambridge C1 Advanced grade C. IELTS must be a physical test.
Timeline
CORU says recognition can take up to 4 months from the file being deemed complete. Incomplete applications are closed after six months.
Good to know
UK BSc and MSc occupational therapy graduates can use the Commonly Aligned Standards fast-track pathway.
Occupational therapists in Ireland: full guide
About CORUWorking in Ireland

Germany: State health authority (Land)

Ergotherapeutin / Ergotherapeut

Requirements
Authorisation to use the professional title from the competent authority of the state where you will work. You need equivalence of your qualification, personal aptitude, medical fitness and German. Documents must be in German, translated by sworn translators.
Exams
If your training is not equivalent, a compensation measure: an adaptation period or a knowledge test for qualifications from outside the EU, or an adaptation period or aptitude test for EU qualifications.
Language
German at CEFR level B2. The certificate can be provided later in the procedure.
Timeline
The authority confirms receipt within one month; the Recognition Finder says a decision follows within 4 months of a complete file, which can be extended.
Good to know
In Berlin the Recognition Finder lists a procedure cost of €25 to €430, plus translations and any compensation measure.
Occupational therapists in Germany: full guide
Working in Germany

Netherlands: BIG

Ergotherapeut (article 34 protected training title, not BIG-registered)

Requirements
Recognition of your foreign diploma by the CIBG: the certificate of competence (verklaring van vakbekwaamheid) for diplomas from outside the EU, or recognition of professional qualifications for EU diplomas. The Commission for Foreign Healthcare Graduates (CBGV) advises.
Exams
No BI test for this profession. The commission may require an adaptation internship, a practical skills test or additional training of 3 months to 2 years.
Language
Dutch at B2 through the NT2 State Exam (or CNaVT from abroad) and English reading at B1, the levels the CIBG sets for hbo professions such as occupational therapist.
Timeline
The CIBG says the certificate of competence takes 6 to 18 months on average from a complete application, with an intended decision within 6 weeks of the file reaching the commission.
Good to know
The CIBG says the certificate of competence application is currently free, and article 34 professionals may work from the moment they receive recognition.
About the BIG registerWorking in the Netherlands

United States: NBCOT

Occupational Therapist Registered (OTR)

Requirements
If you did not graduate from an ACOTE-accredited programme, approval through the Occupational Therapist Eligibility Determination (OTED): an entry-level OT master's, or an OT bachelor's with a post-professional OT master's or doctorate or a master's in a related field, and at least 960 hours of fieldwork. Fee $850; approval valid 7 years.
Exams
The OTR certification exam: four hours, computer-based, 180 items including single-response multiple-choice items and six-option multi-select scenario sets. Retakes after 30 days for the second and third attempts.
English
NBCOT's eligibility page sets no English test for OTED. Transcripts and syllabi not in English must be translated by a certified translator and sent directly to NBCOT.
Timeline
OTED review depends on how quickly your university sends transcripts and syllabi. NBCOT exams are scored on set score dates; test at least three days before the date you want results.
Good to know
OTED documents include official transcripts, course syllabi, a Program Director Form, verification of every OT licence and a professional practice history form.
Occupational therapists in the United States: full guide
Working in the United States

United States: State OT licensing board

State occupational therapy licence

Requirements
The BLS says all states require occupational therapists to be licensed. Each state board sets its own application, fees and any jurisprudence requirements.
Exams
States use the national exam; passing it lets you use the OTR credential.
English
Set by each state.
Timeline
Set by each state. You can ask NBCOT to send your score to state boards when you apply for the exam.
Good to know
NBCOT certification and a state licence are separate; you need the licence to practise.
Occupational therapists in the United States: full guide
Working in the United States

The route, step by step

  1. Check your degree level and fieldwork hours

    Find out your total supervised practice placement (fieldwork) hours and the level of your degree. NBCOT's OTED needs at least 960 hours and usually master's-level education, and the HCPC and CORU both look closely at placements. If your hours are low, find out early whether extra training or experience can fill the gap.

  2. Choose the regulator and route

    Use the HCPC international route for the UK, CORU recognition for Ireland (the fast track if you trained in the UK), the Recognition Finder for Germany, the CIBG certificate of competence for the Netherlands and NBCOT OTED for the USA. Confirm the route before paying any fee.

  3. Pass the language test

    IELTS Academic 7.0 with no band below 6.5 meets both the HCPC and CORU rules for OTs; OET Occupational Therapy also works if you meet each regulator's grades. Germany needs German at B2, and the Netherlands needs NT2 B2 Dutch plus English reading at B1. Keep certificates within two years of applying.

  4. Ask your university for the documents early

    The HCPC needs a course information form, CORU needs verification forms signed and stamped by your university, and NBCOT needs official transcripts, course syllabi from the time you studied and a Program Director Form. Universities can take months, especially for old syllabi.

  5. Get licence verification and good standing

    Request verification from every regulator you have been registered with. NBCOT asks you to verify all active and expired licences, and Germany asks for good conduct and medical certificates no more than three months old.

  6. Arrange certified copies and translations

    CORU accepts certified copies and certified English translations. Germany needs documents in German by sworn translators. NBCOT needs both the original and translated versions sent directly by a certified translator.

  7. Submit and respond to any compensation measure

    If gaps are found, you may face a test of competence (UK), an adaptation period or aptitude test (Ireland, and EU applicants in Germany), a knowledge test (Germany, non-EU qualifications) or extra training or an adaptation internship (Netherlands).

  8. Register or license, then secure the job and visa

    In Ireland, apply to register after CORU recognises your qualification. In the USA, pass the OTR exam and apply for a state licence. In the UK, pay the HCPC registration fee and check that your employer can sponsor the Health and Care Worker visa, since many OT posts are in local authorities.

Exam preparation

In the UK, Ireland, Germany and the Netherlands, OTs are assessed on paper, with a professional discussion, aptitude test, knowledge test or adaptation period only where gaps are found. The written exam is the NBCOT OTR exam in the USA: four hours, 180 items mixing three- and four-option single-response multiple-choice items and six-option multi-select scenario sets. Its domains are Evaluation and Assessment (23%), Analysis, Interpretation and Planning (23%), Select and Manage Interventions (38%) and Competency and Practice Management (16%).

Tips

  • Weight your revision by NBCOT's domain percentages: interventions alone are 38% of the OTR exam.
  • Download the current OTR exam content outline from NBCOT and map each task statement to your own clinical examples.
  • Practise scenario sets, where several questions share one case, as well as single-answer items.
  • Book the exam at least three days before the NBCOT score date you want, because results are released on set dates.
  • For an HCPC test of competence, prepare examples from both physical and mental health practice, not only your specialty.
  • For a CORU aptitude test, concentrate on the substantial differences listed in your decision; the test covers only those.
  • Allow time between attempts: NBCOT requires 30 days before a second or third attempt and 60 days before the fourth to sixth.

Topics that come up

  • Occupation-based evaluation and standardised assessment
  • Analysis, interpretation and intervention planning
  • Activities of daily living and instrumental ADLs
  • Neurological rehabilitation
  • Musculoskeletal conditions and hand therapy
  • Mental health and psychosocial practice
  • Paediatrics and developmental conditions
  • Older adults, falls and cognition
  • Assistive technology, seating and environmental adaptation
  • Discharge planning and community practice
  • Evidence-based practice, documentation and professional standards

Pay by country

Pay figures come from official scales where they exist and are not directly comparable. The UK figures are NHS Agenda for Change pay points in England from 1 April 2026; local authority OT posts use council pay scales instead. The Irish figures are HSE consolidated salary scales from 1 June 2026. The US figure is a BLS median, not a scale.

  • UK£32,073 to £39,043 (Band 5); £39,959 to £48,117 (Band 6), NHS 2026/27NHS Health Careers says OTs typically start on Band 5. Band 7 is £49,387 to £56,515.
  • Ireland€45,514 to €65,068 (Occupational therapist, HSE scale from 1 June 2026)Senior OT €65,197 to €76,767; clinical specialist OT €72,119 to €83,689. The top points include long service increments.
  • GermanySet by employer or the collective agreement that appliesMany OTs work in private practices as well as hospitals and rehabilitation clinics; ask each employer which agreement applies.
  • NetherlandsSet by the collective labour agreement (CAO) that applies to the employerWe could not confirm a current figure from an official scale. Ask the employer which CAO and salary scale apply.
  • USA$100,330 median annual pay for occupational therapists (BLS, 2025)Pay varies widely by state and setting.

See your NHS band and annual pay

Career growth

Occupational therapy careers grow through specialist clinical practice, advanced practice and service leadership, and both the NHS and the HSE have named grades for each step.

  1. Specialist occupational therapist

    NHS specialist OT posts are typically Band 6. The HSE has a senior occupational therapist grade above the staff grade.

  2. Clinical specialist and highly specialist roles

    The HSE has a clinical specialist occupational therapist grade, and NHS highly specialist and team lead roles are typically Band 7.

  3. Advanced practice

    NHS advanced practitioner and service lead roles sit at Band 8a. Banding for senior roles is set locally.

  4. Management

    The HSE has occupational therapist manager grades, including manager in charge III, for people who run services.

  5. Practice settings beyond hospitals

    NHS Health Careers says OTs work in hospitals, clinics, charities, prisons and social services departments, and the Recognition Finder lists rehabilitation clinics, psychiatric institutions, schools and specialist OT practices in Germany.

Common mistakes

  1. 1

    Applying to NBCOT OTED with a bachelor's degree only; OTED needs an entry-level master's or a bachelor's combined with a further master's or doctorate.

  2. 2

    Not counting fieldwork hours before applying; NBCOT needs at least 960 hours from the degree-granting institution.

  3. 3

    Leaving syllabi requests too late; NBCOT and CORU both need course content from the time you studied, which old universities may struggle to find.

  4. 4

    Using an IELTS One Skill Retake for Ireland; CORU does not accept it.

  5. 5

    Taking a non-OT version of OET; the HCPC and CORU accept only the occupational therapy OET for this register.

  6. 6

    Accepting a UK local authority job without checking whether it can sponsor a Health and Care Worker visa.

  7. 7

    Expecting BIG registration in the Netherlands; ergotherapeut is an article 34 profession that needs CIBG recognition instead.

  8. 8

    Letting OTED approval lapse: you must pass the OTR exam within 7 years or start again.

How we help occupational therapists

  • Review of your qualifications, transcripts, experience and current registration

  • Check against the published requirements of the regulators you choose

  • Check of how recent your practice is and whether any gap in practice affects your route

  • English or other language requirement for each route, with any exemption you may qualify for

  • Comparison of routes and countries, with the trade-offs explained

  • List of the exams, aptitude tests or adaptation periods each route is likely to involve

  • Written roadmap: exams, English test, documents, fees and timeline

  • Budget built from the official regulator, exam and verification fees, kept separate from our own fee

  • Flags for slow steps to start first, such as primary source verification and language learning

  • A call to walk you through the plan and answer your questions

What our eligibility assessment includesPackages and fees

Questions

Yes, once you are on the HCPC Register; occupational therapist is a protected title. The HCPC assesses your training and experience against its OT standards of proficiency, with two occupational therapist assessors deciding on paper. There is no written licensing exam.

Both the HCPC and CORU ask for IELTS 7.0 overall with no element below 6.5. For OET Occupational Therapy, the HCPC asks for 1400 overall with no element below 300, while CORU asks for grade B (350) in three components and at least C+ (300) in the fourth.

CORU says recognition can take up to 4 months from the time your file is deemed complete. Recognition is a separate step that must come before your registration application, which includes Garda vetting and police clearance.

Yes. CORU's Commonly Aligned Standards fast-track pathway covers UK BSc and MSc programmes in occupational therapy. CORU says it involves significantly fewer documents and a much shorter timeline.

You complete a compensation measure. That is either a supervised period of adaptation in Ireland, up to 3 years long, or an aptitude test, which must be offered within six months and costs €500. One repeat is allowed for each.

Yes. Ergotherapeut is a regulated profession under the Ergotherapeutengesetz, and the Recognition Finder says you need German at B2 for authorisation to use the title. You can provide the language certificate later in the procedure.

No. Ergotherapeut is an article 34 profession with a protected training title, not a BIG-registered profession. With a foreign diploma you need recognition from the CIBG, and the CIBG says you may work from the moment you receive it.

The CIBG sets the level by education level. For higher vocational (hbo) professions, which it says include occupational therapist, you need Dutch at B2 through the NT2 State Exam and English reading at B1. Certificates must be no more than two years old.

Through NBCOT's Occupational Therapist Eligibility Determination (OTED). You need an entry-level master's in OT, a bachelor's in OT with a post-professional OT master's or doctorate, or a bachelor's in OT with a master's in a related field, plus at least 960 hours of fieldwork. The application fee is $850.

It is a four-hour computer-based exam with 180 items: three- and four-option single-response multiple-choice items and six-option multi-select scenario sets. The largest domain, Select and Manage Interventions, makes up 38% of the exam.

NBCOT says OTED approvals are valid for 7 years. You must take and pass the OTR exam within that time, or reapply, pay the fee again and resubmit your documents.

Yes. The Bureau of Labor Statistics says all states require occupational therapists to be licensed, and passing the national exam lets you use the OTR credential. Check the requirements of the state board where you plan to work.

Sources

  1. 1HCPC: International applications
  2. 2HCPC: Certificate of English language proficiency
  3. 3HCPC: Registration fees for applicants
  4. 4HCPC: What to expect when you make an international application
  5. 5HCPC: Test of competence
  6. 6HCPC: Standards of proficiency for occupational therapists
Show all 32 sources
  1. 7NHS Employers: Pay scales for 2026/27
  2. 8NHS Health Careers: Occupational therapist
  3. 9GOV.UK: Health and Care Worker visa, your job
  4. 10CORU: About the Occupational Therapists Registration Board
  5. 11CORU: How to apply (international applicants)
  6. 12CORU: Guidance notes for international qualification applicants (revised 2026)
  7. 13CORU: International applicant leaflet
  8. 14CORU: International qualifications FAQs
  9. 15CORU: Compensation measures
  10. 16CORU: Fast Track Pathway (Commonly Aligned Standards)
  11. 17CORU: Language requirements
  12. 18HSE: Consolidated salary scales from 1 June 2026
  13. 19Anerkennung in Deutschland: Recognition Finder, Occupational therapist (Berlin)
  14. 20Ergotherapeutengesetz (ErgThG)
  15. 21BIG-register: Overige beroepen (artikel 34 beroepen)
  16. 22BIG-register: Employee with a foreign diploma
  17. 23BIG-register: Certificate of competence
  18. 24BIG-register: Dutch language skills and English reading skills
  19. 25BIG-register: English reading skills
  20. 26BIG-register: Processing time and costs
  21. 27BIG-register: Recognition of professional qualifications (EU)
  22. 28NBCOT: Eligibility and OTED for internationally educated applicants
  23. 29NBCOT: OTED FAQ
  24. 30NBCOT: Certification Examination Handbook for OTR and COTA candidates
  25. 31BLS Occupational Outlook Handbook: Occupational therapists
  26. 32RCOT: becoming an occupational therapist in the UK from abroad

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