Work as an occupational therapist in the USA: NBCOT (2026)

• Your entry-level occupational therapy degree was not earned at a US program accredited by ACOTE, so you must apply through OTED before you can sit the NBCOT exam.
• You hold an entry-level master's in OT, or a bachelor's in OT with a post-professional master's or doctorate in OT, or a bachelor's in OT with a master's in a related field.
• You completed at least 960 hours of fieldwork through your entry-level degree-granting institution, at bachelor's level or above.
• Your university is recognized by your national government and can send transcripts, syllabi, the Verification of Academic Credential Form and the Program Director Form directly to NBCOT.
• Every OT license, registration or certification you have held can be verified and is unencumbered, and you can document your practice history.
• You can pass NBCOT's character review and agree to the NBCOT Code of Conduct.
• For a work visa, you can meet the English requirement for the VCVC or VisaScreen (unless you graduated from an OT program in Australia, Canada except Quebec, Ireland, New Zealand, the UK or the US).
• You have, or can get, a US Social Security number before licensing in states such as California, which says it cannot issue a license without one.
• NBCOT notes that earning a post-professional OT master's or doctorate in the US does not guarantee OTED approval.

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• CGFNSCGFNS International

  Credentials evaluation and VisaScreen for nurses and allied health

  How to register with the CGFNS

1. 1

   Check your degree against the OTED rule

   Compare your qualifications with NBCOT's three accepted degree combinations and the 960-hour fieldwork minimum. If you only hold a bachelor's in OT, you will need a master's in OT or a related field before OTED can succeed. Find out now, because this is the most common reason foreign-trained OTs are found ineligible.
2. 2

   Prepare your OTED documents

   Download NBCOT's OTED documentation checklist. You need national government recognition documents for your university, official final transcripts, the Verification of Academic Credential Form, course syllabi from the year you graduated, the Program Director Form, verification of every OT license or registration, and the Professional Practice History Form. Universities must send records directly to NBCOT by a secure platform such as Parchment or DocuSign, or by post with official seals; translations must come from a certified translator along with the originals.
3. 3

   Apply for OTED and pay $850

   Create one MyNBCOT account (a duplicate account costs $35) and submit the OTED application. NBCOT says the fee is not refundable once you have paid and started. On approval you receive an OTED ID, which you need for the exam application, and the approval lasts seven years.
4. 4

   Apply for the NBCOT OTR exam

   The online application costs $540 ($595 on paper, which takes longer). Order your free score transfer to the state you plan to license in, because states only receive scores you request and further transfers cost $35 each. OTED-approved candidates do not send another transcript. The application is valid for 90 days, so apply when you can test within that window.
5. 5

   Schedule and sit the exam with Pearson

   NBCOT says your Authorization to Test (ATT) letter usually arrives within three business days of approval and is active for 90 days. The OTR exam is a four-hour, computer-based test at a Pearson test center, with 180 items. Rescheduling less than 48 hours before your appointment means a $115 fee to reissue the ATT.
6. 6

   Get your English test and visa credential

   If you are not exempt, take an accepted English test at a test center (TruMerit does not accept at-home versions). Then apply for NBCOT's VCVC ($500), which needs a passing OTR score, or TruMerit's VisaScreen ($740). Both certificates last five years, and federal rules say the certificate must be valid when your visa is issued and when you are admitted.
7. 7

   Apply for a state license

   Each state board sets its own rules. California, for example, charges a $50 application fee, requires fingerprints through Live Scan and a Social Security number before issuing a license, and tells you the prorated license fee in your approval letter. Texas requires a 20-question online jurisprudence exam (no fee) and fingerprints, and wants your NBCOT score sent directly by NBCOT.
8. 8

   Secure a job offer and the right visa

   Most employers sponsor OTs on an H-1B petition or, for Canadians and Mexicans, TN status; some sponsor a green card directly. OT is not on Schedule A, so permanent residence goes through standard labor certification. Read the employer's offer carefully for who pays sponsorship, credentialing and relocation costs and what happens if you leave early.
9. 9

   Keep certification and license current

   NBCOT certification renews online for $65, and you must complete the continuing competence your state requires. Renew the VCVC or VisaScreen before it expires if you are still on a temporary visa. Plan for a separate license in each state where you treat patients until the OT Compact is operational.

• NBCOT Occupational Therapist Registered (OTR) certification exam

  A four-hour, computer-based exam with 180 items: three- and four-option single-response multiple-choice items plus multi-select scenario sets, where each item has six options and you choose the three best. NBCOT's January 2024 blueprint weights the domains as evaluation and assessment 23%, analysis, interpretation and planning 23%, select and manage interventions 38%, and competency and practice management 16%. Scores run from 300 to 600 and 450 is the pass mark. It is taken at Pearson test centers.

• OTED review (not an exam)

  OTED is a document-based eligibility review of your degree, syllabi and fieldwork against current US entry-level education. There is no test, but an approval is required before an internationally educated OT can apply for the OTR exam.

• State jurisprudence exams

  Some states test you on their OT law and rules. Texas, for example, uses a 20-question, open-book online jurisprudence exam that is free and can be retaken until you pass. Check your state board's application page.

• Retake rules

  If you fail, NBCOT's waiting period is 30 days for attempts 2 to 4, 60 days for attempts 5 to 7 and 90 days from attempt 8 onward. An online retake application costs $430. Your feedback report shows domain-level performance to guide revision.

• English test for the visa credential

  TOEFL iBT or Cambridge English for the NBCOT VCVC; Cambridge, TOEFL iBT, IELTS, MET, OET or PTE for TruMerit VisaScreen. Tests must be taken in person at a test center.

• NBCOT's OTED pages do not set an English score for exam eligibility. English testing comes in through the federal health care worker certificate you need for a work visa, and through any state board that sets its own rule.
• NBCOT VCVC: TOEFL iBT 4.5 overall, 4.5 Speaking and 3.5 in Reading, Listening and Writing, or Cambridge English (B2 First, C1 Advanced or C2) 169 overall and 194 Speaking. Scores are valid for two years from the test date.
• TruMerit VisaScreen, scores for occupational therapists effective May 12, 2026: IELTS 6.5 overall with 7 Speaking; TOEFL iBT 4.5 overall, 4.5 Speaking, 3.5 Reading, Listening and Writing; OET 360 Speaking, 340 Reading, 350 Writing, 320 Listening; PTE 55 overall, 76 Speaking, 62 Reading, Writing and Listening; MET 58 overall, 59 Speaking; Cambridge 169 overall, 194 Speaking.
• At-home versions of English tests are not accepted for VisaScreen.
• Exemption: NBCOT exempts graduates of OT programs in Australia, Canada (except Quebec), Ireland, New Zealand, the UK and the US. TruMerit applies the same country list where English was the language of instruction.
• Older guides quote TOEFL iBT scores out of 120. The thresholds above are on the newer 1 to 6 band scale, so check which scale your score report uses before you book.

Estimate your total cost

• Allow one to three months to collect OTED documents, as universities must send transcripts, syllabi and forms directly to NBCOT. NBCOT does not publish an OTED decision time.
• Once OTED is approved, you have seven years to pass the exam. The exam application is valid for 90 days, and NBCOT says it reviews transcripts within up to 10 business days.
• NBCOT says the ATT letter usually arrives within three business days of approval and lasts 90 days, so most people test within one to three months of applying.
• NBCOT mails the VCVC within 10 business days of approving the application. TruMerit says 90% of VisaScreen certificates are issued within 3.5 business days once documentation is validated.
• State licensing time varies by board and background check. California treats incomplete applications as abandoned after two years.
• From starting OTED to working in the US, plan for about a year or more, longer if you first need a master's degree or a green card.

There is no national pay scale. The figures below are US Bureau of Labor Statistics wages for occupational therapists for May 2025. Pay depends on the state, setting and employer.

• Median annual wage (all settings)

  $100,330

  BLS, May 2025.

• Lowest 10 percent

  Less than $71,690

  BLS, May 2025.

• Highest 10 percent

  More than $131,950

  BLS, May 2025.

• Home health care services (median)

  $106,300

• Nursing care facilities (median)

  $105,850

• Hospitals (median)

  $102,820

• Offices of therapists (median)

  $97,940

• Educational services (median)

  $87,300

• Offices of physical, occupational and speech therapists and audiologists, which BLS says employ 28% of OTs.
• Hospitals (26%), including acute care, inpatient rehabilitation and outpatient hand therapy.
• Schools and other educational services (13%), working with children under special education programs.
• Home health care services (8%), visiting patients after hospital discharge.
• Skilled nursing and long-term care facilities (7%).
• Staffing and international recruitment agencies that sponsor visas and place OTs with these employers, usually on fixed-term contracts.

• Health care worker certificate: 8 CFR 212.15 says an immigrant or nonimmigrant coming to work as an OT is inadmissible without a certificate from an approved credentialing organization. For OTs that means NBCOT's VCVC or TruMerit's VisaScreen, valid at visa issuance and admission.
• H-1B: the specialty occupation visa, filed by your employer after a Labor Condition Application. USCIS lists an annual cap of 65,000, plus 20,000 for US master's graduates, an initial stay of up to three years and a total of six. Universities and nonprofit research employers are cap-exempt.
• H-1B $100,000 payment: USCIS says a September 2025 proclamation required it for certain petitions for workers outside the US, and that a June 2026 court order vacated it, though it is administratively stayed pending appeal. Check the USCIS page before your employer files.
• TN: Canadian and Mexican citizens can work as occupational therapists under USMCA with a baccalaureate or licenciatura degree or a state or provincial license, for up to three years at a time. Canadians apply at the port of entry; Mexicans need a TN visa first.
• Green card: occupational therapy is not on Schedule A (which covers physical therapists and nurses only), so employer sponsorship usually goes through standard labor certification. Waits depend on your country of birth.
• This is general information, not immigration advice. Your employer's immigration attorney decides the best route.

1. 1

   A DHA, DOH, MOHAP, SCFHS, QCHP or other GCC OT license does not transfer. You still need OTED, the NBCOT OTR exam and a US state license.

2. 2

   Many OTs working in the Gulf hold only a bachelor's in OT. OTED requires a master's (in OT or a related field) on top, so check this before paying the $850 fee.

3. 3

   Your Gulf experience goes on the Professional Practice History Form, and NBCOT verifies every license you have held. Ask each authority for verification or good standing letters early, and keep your licenses active and unencumbered.

4. 4

   Gulf-trained or Gulf-licensed OTs are not exempt from English testing unless the OT degree itself is from Australia, Canada (except Quebec), Ireland, New Zealand, the UK or the US.

5. 5

   Plan your NBCOT exam date around your Gulf contract: the ATT letter lasts only 90 days, and rescheduling inside 48 hours costs $115.

• Application plan with every step, fee and deadline

• Document checklist tailored to you, and a review of each document before upload

• Timeline built around the regulator's closure windows and document validity periods

• Help completing the application forms accurately and consistently

• Support with profession-specific evidence, such as the HCPC standards of proficiency mapping

• Guidance on certificates of good standing, references and certified translations

• Preparation for identity checks and declarations on health and character

• Tracking your application and help responding to regulator requests

• Next steps after the decision: exams, adaptation, PIN or licence and your first job

Regulators make all registration decisions and set all fees. Our fee is separate from the regulator's fees, exam fees and translation costs.

What our registration and licensing support includesPackages and fees