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Maryland Occupational Therapy — Requirements & Free Practice

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Occupational Therapist

Occupational Therapist license issued by the Maryland Board.

Licensing authority: Maryland State Board of Occupational Therapy Practice · Application information

Initial licensure by examination
Character And Age
Good moral character and at least age 18 (Health Occupations §10-302).
Continuing Competency
Current NBCOT certification or applicable continuing competency documentation under COMAR 10.46.01.02E and 10.46.04.
Criminal History
State and national criminal history records check with fingerprints (§§10-302, 10-302.1).
Education And Fieldwork
Accredited occupational therapy program and six months of supervised full-time fieldwork.
Initial licensure with another state license and discretionary examination waiver
Board Documentation
COMAR 10.46.01.02E also requests initial NBCOT certification or examination verification and verification of every other authorization to practice.
Character And Age
Good moral character and at least age 18 (Health Occupations §10-302).
Continuing Competency
Current NBCOT certification or applicable continuing competency documentation under COMAR 10.46.01.02E and 10.46.04.
Criminal History
State and national criminal history records check with fingerprints (§§10-302, 10-302.1).
Education And Fieldwork
Accredited occupational therapy program and six months of supervised full-time fieldwork.
Exam Waiver
Board may waive the national examination for an applicant licensed elsewhere only on evidence of equivalent qualifications and examination requirements (Health Occupations §10-306).
Other State License
Licensed for occupational therapy or limited occupational therapy in another state.
Initial licensure through pre 1979 national certification
Maryland Board of Occupational Therapy Jurisprudence Examination
Board Documentation
COMAR 10.46.01.02E still asks for initial NBCOT certification or examination verification; the statute controls the waiver.
Character And Age
Good moral character and at least age 18 (Health Occupations §10-302).
Continuing Competency
Current NBCOT certification or applicable continuing competency documentation under COMAR 10.46.01.02E and 10.46.04.
Criminal History
State and national criminal history records check with fingerprints (§§10-302, 10-302.1).
Education And Fieldwork
Accredited occupational therapy program and six months of supervised full-time fieldwork.
Historic Certification
Applicant held the matching AOTCB O.T.R. or C.O.T.A. certification before July 1, 1979 (§10-307(a)); that historical examination is no longer a currently offered requirement leaf.
National Exam Waiver
Health Occupations §10-307(a) mandates waiver of the national examination for the qualifying historic certification.
Reactivation after elective nonrenewal
Character And Age
Good moral character and at least age 18 (Health Occupations §10-302).
Continuing Competency
Current NBCOT certification or applicable continuing competency documentation under COMAR 10.46.01.02E and 10.46.04.
Criminal History
State and national criminal history records check with fingerprints (§§10-302, 10-302.1).
Education And Fieldwork
Accredited occupational therapy program and six months of supervised full-time fieldwork.
Prior Exam Evidence
COMAR 10.46.01.02I requests verification of initial NBCOT certification or examination, even if the applicant passed before applying.
Prior Status
License was rendered inactive through elective nonrenewal; file reactivation application and applicable fee.
Reinstatement after expiration
Character And Age
Good moral character and at least age 18 (Health Occupations §10-302).
Continuing Competency
Current NBCOT certification or applicable continuing competency documentation under COMAR 10.46.01.02E and 10.46.04.
Criminal History
State and national criminal history records check with fingerprints (§§10-302, 10-302.1).
Education And Fieldwork
Accredited occupational therapy program and six months of supervised full-time fieldwork.
Prior Exam Evidence
COMAR 10.46.01.02I requests verification of initial NBCOT certification or examination, even if the applicant passed before applying.
Prior Status
License expired after failure to renew; complete renewal/continuing competency and reinstatement requirements under §10-312.
Reinstatement of revoked license
No examination is required for this applicant pathway.
Revocation
On application by an individual whose license was revoked, the Board may reinstate by affirmative vote of a majority of its full authorized membership (§10-318).

Official no-examination sources

Effective from 2026-09-22.

Renewal of active license
No examination is required for this applicant pathway.
Renewal
Complete renewal application, fee, continuing competency attestation, and applicable criminal history check; a 30-day late renewal window carries a late fee (Health Occupations §10-311; COMAR 10.46.01.02B).

Official no-examination sources

Effective from 2026-09-22.

Temporary Occupational Therapist License

Temporary supervised license pending certification examination results.

Licensing authority: Maryland State Board of Occupational Therapy Practice · Application information

First temporary license for certification examination candidate
Character And Age
Good moral character and at least age 18 (Health Occupations §10-302).
Continuing Competency
Current NBCOT certification or applicable continuing competency documentation under COMAR 10.46.01.02E and 10.46.04.
Criminal History
State and national criminal history records check with fingerprints (§§10-302, 10-302.1).
Education And Fieldwork
Accredited occupational therapy program and six months of supervised full-time fieldwork.
Exam Status
Eligible and registered to take the NBCOT certification examination within the eligibility activation period; passing result remains pending.
Supervision
Practice only under the supervision specified in Health Occupations §10-313 and COMAR 10.46.01.04.
Second temporary license after first temporary license expires
Character And Age
Good moral character and at least age 18 (Health Occupations §10-302).
Continuing Competency
Current NBCOT certification or applicable continuing competency documentation under COMAR 10.46.01.02E and 10.46.04.
Criminal History
State and national criminal history records check with fingerprints (§§10-302, 10-302.1).
Education And Fieldwork
Accredited occupational therapy program and six months of supervised full-time fieldwork.
Limit
Board may issue no more than two temporary licenses to one individual (§10-313(d)).
Prior Temporary
Initial temporary license expired; applicant remains eligible and registered for the certification examination.
Updated Documents
Submit updated application documents that expired and the second temporary license fee (COMAR 10.46.01.02G).

Occupational Therapy Assistant

Occupational Therapy Assistant license issued by the Maryland Board.

Licensing authority: Maryland State Board of Occupational Therapy Practice · Application information

Initial licensure by examination
Character And Age
Good moral character and at least age 18 (Health Occupations §10-302).
Continuing Competency
Current NBCOT certification or applicable continuing competency documentation under COMAR 10.46.01.02E and 10.46.04.
Criminal History
State and national criminal history records check with fingerprints (§§10-302, 10-302.1).
Education And Fieldwork
Accredited occupational therapy assistant program and four months of supervised full-time fieldwork.
Initial licensure with another state license and discretionary examination waiver
Board Documentation
COMAR 10.46.01.02E also requests initial NBCOT certification or examination verification and verification of every other authorization to practice.
Character And Age
Good moral character and at least age 18 (Health Occupations §10-302).
Continuing Competency
Current NBCOT certification or applicable continuing competency documentation under COMAR 10.46.01.02E and 10.46.04.
Criminal History
State and national criminal history records check with fingerprints (§§10-302, 10-302.1).
Education And Fieldwork
Accredited occupational therapy assistant program and four months of supervised full-time fieldwork.
Exam Waiver
Board may waive the national examination for an applicant licensed elsewhere only on evidence of equivalent qualifications and examination requirements (Health Occupations §10-306).
Other State License
Licensed for occupational therapy or limited occupational therapy in another state.
Initial licensure through pre 1979 national certification
Maryland Board of Occupational Therapy Jurisprudence Examination
Board Documentation
COMAR 10.46.01.02E still asks for initial NBCOT certification or examination verification; the statute controls the waiver.
Character And Age
Good moral character and at least age 18 (Health Occupations §10-302).
Continuing Competency
Current NBCOT certification or applicable continuing competency documentation under COMAR 10.46.01.02E and 10.46.04.
Criminal History
State and national criminal history records check with fingerprints (§§10-302, 10-302.1).
Education And Fieldwork
Accredited occupational therapy assistant program and four months of supervised full-time fieldwork.
Historic Certification
Applicant held the matching AOTCB O.T.R. or C.O.T.A. certification before July 1, 1979 (§10-307(a)); that historical examination is no longer a currently offered requirement leaf.
National Exam Waiver
Health Occupations §10-307(a) mandates waiver of the national examination for the qualifying historic certification.
Reactivation after elective nonrenewal
Character And Age
Good moral character and at least age 18 (Health Occupations §10-302).
Continuing Competency
Current NBCOT certification or applicable continuing competency documentation under COMAR 10.46.01.02E and 10.46.04.
Criminal History
State and national criminal history records check with fingerprints (§§10-302, 10-302.1).
Education And Fieldwork
Accredited occupational therapy assistant program and four months of supervised full-time fieldwork.
Prior Exam Evidence
COMAR 10.46.01.02I requests verification of initial NBCOT certification or examination, even if the applicant passed before applying.
Prior Status
License was rendered inactive through elective nonrenewal; file reactivation application and applicable fee.
Reinstatement after expiration
Character And Age
Good moral character and at least age 18 (Health Occupations §10-302).
Continuing Competency
Current NBCOT certification or applicable continuing competency documentation under COMAR 10.46.01.02E and 10.46.04.
Criminal History
State and national criminal history records check with fingerprints (§§10-302, 10-302.1).
Education And Fieldwork
Accredited occupational therapy assistant program and four months of supervised full-time fieldwork.
Prior Exam Evidence
COMAR 10.46.01.02I requests verification of initial NBCOT certification or examination, even if the applicant passed before applying.
Prior Status
License expired after failure to renew; complete renewal/continuing competency and reinstatement requirements under §10-312.
Reinstatement of revoked license
No examination is required for this applicant pathway.
Revocation
On application by an individual whose license was revoked, the Board may reinstate by affirmative vote of a majority of its full authorized membership (§10-318).

Official no-examination sources

Effective from 2026-09-22.

Renewal of active license
No examination is required for this applicant pathway.
Renewal
Complete renewal application, fee, continuing competency attestation, and applicable criminal history check; a 30-day late renewal window carries a late fee (Health Occupations §10-311; COMAR 10.46.01.02B).

Official no-examination sources

Effective from 2026-09-22.

Temporary Occupational Therapy Assistant License

Temporary supervised license pending certification examination results.

Licensing authority: Maryland State Board of Occupational Therapy Practice · Application information

First temporary license for certification examination candidate
Character And Age
Good moral character and at least age 18 (Health Occupations §10-302).
Continuing Competency
Current NBCOT certification or applicable continuing competency documentation under COMAR 10.46.01.02E and 10.46.04.
Criminal History
State and national criminal history records check with fingerprints (§§10-302, 10-302.1).
Education And Fieldwork
Accredited occupational therapy assistant program and four months of supervised full-time fieldwork.
Exam Status
Eligible and registered to take the NBCOT certification examination within the eligibility activation period; passing result remains pending.
Supervision
Practice only under the supervision specified in Health Occupations §10-313 and COMAR 10.46.01.04.
Second temporary license after first temporary license expires
Character And Age
Good moral character and at least age 18 (Health Occupations §10-302).
Continuing Competency
Current NBCOT certification or applicable continuing competency documentation under COMAR 10.46.01.02E and 10.46.04.
Criminal History
State and national criminal history records check with fingerprints (§§10-302, 10-302.1).
Education And Fieldwork
Accredited occupational therapy assistant program and four months of supervised full-time fieldwork.
Limit
Board may issue no more than two temporary licenses to one individual (§10-313(d)).
Prior Temporary
Initial temporary license expired; applicant remains eligible and registered for the certification examination.
Updated Documents
Submit updated application documents that expired and the second temporary license fee (COMAR 10.46.01.02G).

Maryland Board of Occupational Therapy Jurisprudence Examination

Provider
Maryland State Board of Occupational Therapy Practice
Format
Open book Yes/No answer sheet
Exam questions
35
Examination outline
  • Maryland Occupational Therapy Practice Act
  • COMAR 10.46.01 General Regulations
  • COMAR 10.46.02 Code of Ethics
  • COMAR 10.46.03 Procedure for Board Hearings
  • COMAR 10.46.04 Continuing Competency Requirement
  • COMAR 10.46.06 Competency Requirements for Physical Agent Modalities
  • COMAR 10.46.07 Sanctioning Guidelines
Examination sources

OTR exam

Format
Three- and four-option single-response multiple-choice items and six-option multi-select scenario sets
Exam questions
180 items
Examination outline
  • Domain 1 — Evaluation and Assessment: Acquire information regarding factors that influence occupational performance on an ongoing basis throughout the occupational therapy process. (23%)
    • Task 1: Identify the influence of development and lived experience; body functions and body structures; values, beliefs, and spirituality; and identity on occupational performance.
    • Task 1 knowledge 1: Impact of typical development and aging on occupational performance, health, and wellness across the life span.
    • Task 1 knowledge 2: Expected patterns, progressions, and prognoses associated with conditions that limit occupational performance. Examples include signs and symptoms of disease; stages of disease; secondary complications.
    • Task 1 knowledge 3: Impact of body functions and body structures on occupational performance. Examples include cognitive impairments; congenital anomalies.
    • Task 1 knowledge 4: Influence of lived experiences and identity on occupational performance. Examples include history of trauma and adverse childhood events; socioeconomic status; gender, race, culture, religion.
    • Task 2: Assess a client’s functional skills, roles, prioritized needs and wants, and performance context to evaluate their occupational performance.
    • Task 2 knowledge 1: Resources and considerations for acquiring information about the client’s current condition and occupational performance. Examples include referrals; client records; developmental history; Individualized Education Program (IEP) plans; theoretical approach and frame of reference.
    • Task 2 knowledge 2: Administration, purpose, indications, advantages, and limitations of standardized and nonstandardized screening and assessment tools. Examples include criterion-referenced tests; norm-referenced tests; client and caregiver interviews; observation.
    • Task 2 knowledge 3: Internal and external factors influencing a client’s engagement in occupation. Examples include roles, habits, routines, and rituals; environmental context; family and social supports; medication side effects and interactions; mental health.
    • Task 3: Perform an activity analysis to determine the influence of task demands, current conditions, performance skills, and context on occupation.
    • Task 3 knowledge 1: Task requirements, steps to task completion, and task demands across contexts or settings.
    • Task 3 knowledge 2: Personal and environmental factors that facilitate or inhibit task completion or occupational engagement. Examples include compensation patterns; role of performance context; influence of current conditions.
  • Domain 2 — Analysis, Interpretation, and Planning: Formulate conclusions regarding client needs and priorities to develop and monitor an intervention plan throughout the occupational therapy process. (23%)
    • Task 1: Synthesize assessment results to determine eligibility for services and establish a client-centered intervention plan.
    • Task 1 knowledge 1: Interpretation and analysis of quantitative assessments. Examples include statistical terminology; scoring; limitations of scores; client reactions to testing.
    • Task 1 knowledge 2: Interpretation of qualitative findings. Examples include occupational profile; outcomes of needs assessment; results from interviews or observations.
    • Task 1 knowledge 3: Integration and application of quantitative assessment results and qualitative findings to guide critical decision-making and prioritize needs.
    • Task 2: Collaborate with the client, the client’s relevant others, occupational therapy colleagues, and other professionals using a client-centered approach and therapeutic use of self to manage occupational therapy services.
    • Task 2 knowledge 1: Roles and responsibilities among interprofessional teams when coordinating client care and providing services. Examples include referral to and consultation with other services; interprofessional communication methods; scope of practice.
    • Task 2 knowledge 2: Processes for managing interprofessional intervention plans. Examples include Individualized Education Program (IEP) plans; discharge plans; transition plans; palliative and hospice care plans.
    • Task 2 knowledge 3: Client-centered approaches and considerations for coordinating occupational therapy services. Examples include therapeutic use of self; advocacy; frequency/duration of intervention; level of service delivery.
    • Task 2 knowledge 4: Factors used to prioritize intervention goals and activities in collaboration with the client and family, teacher, caregiver, and relevant others. Examples include client-reported outcomes; level of support required; context of service delivery; progress toward goals.
    • Task 2 knowledge 5: Strategies for addressing and enhancing health literacy with the client and relevant others. Examples include caregiver training; teaching-learning models; methods for making health information accessible; informed decision-making; navigating challenges to professional expertise.
    • Task 3: Monitor and modify the intervention plan, approach, context, and goals on an ongoing basis using clinical reasoning.
    • Task 3 knowledge 1: Factors for determining and managing context and activities to meet individual and group intervention goals and objectives. Examples include client needs and priorities; response to intervention.
    • Task 3 knowledge 2: Strategies for monitoring the effectiveness of individual and group interventions. Examples include client-reported outcomes; reevaluation results; progress toward goals.
    • Task 3 knowledge 3: Clinical decision-making for assessing and adapting the intervention plan and prioritizing goals based on client response to intervention. Examples include physiological changes; behavioral reactions; emotion regulation; developmental needs.
    • Task 3 knowledge 4: Precautions or contraindications associated with a client’s condition or stage of recovery. Examples include postsurgical precautions; vital signs; laboratory values; suicidal ideation.
  • Domain 3 — Select and Manage Interventions: Select and implement interventions for managing a client-centered plan throughout the occupational therapy process. (38%)
    • Task 1: Incorporate preparatory techniques, activities, and modalities as an adjunct to interventions to promote healing and enhance engagement in occupation-based activities.
    • Task 1 knowledge 1: Considerations for selecting, preparing, and adapting the intervention technique to support optimal engagement and promote goal achievement. Examples include client condition; client safety.
    • Task 1 knowledge 2: Considerations for selecting, preparing, and adapting the intervention environment to support optimal engagement and promote goal achievement. Examples include ensuring privacy during telehealth sessions; equipment safety; line management.
    • Task 1 knowledge 3: Indications, contraindications, and precautions associated with wound management and maintaining skin integrity. Examples include stage of wound healing; prevention and management of pressure ulcers.
    • Task 1 knowledge 4: Indications, contraindications, precautions, and clinical application of superficial thermal agents. Examples include dry whirlpool; hot packs; cryotherapy.
    • Task 1 knowledge 5: Indications, contraindications, precautions, and clinical application of deep thermal, mechanical, and electrotherapeutic physical agent modalities. Examples include transcutaneous and neuromuscular electrical stimulation; biofeedback.
    • Task 2: Implement occupation-based strategies to support participation in activities of daily living (ADL), instrumental activities of daily living (IADL), health management, rest and sleep, education, work, play, leisure, and social participation across the life span.
    • Task 2 knowledge 1: Interventions for supporting leisure and play.
    • Task 2 knowledge 2: Methods for grading an activity, task, or technique based on level of development, client status, response to intervention, and client needs.
    • Task 2 knowledge 3: Considerations for facilitating individual and group participation in shared activities. Examples include group processes; group dynamics; group type and function.
    • Task 2 knowledge 4: Interventions to support cognitive, visual-motor, visual, and perceptual processing and sensory arousal. Examples include sensory modulation; proprioceptive input; vestibular strategies; low vision strategies.
    • Task 2 knowledge 5: Compensatory and remedial strategies for managing cognitive and perceptual deficits or developmental disabilities. Examples include graded cueing; chaining; metacognition; memory aids.
    • Task 2 knowledge 6: Adaptive and preventive strategies for supporting optimal engagement in occupation. Examples include use of technology/apps; joint protection; task simplification; energy conservation.
    • Task 2 knowledge 7: Intervention strategies and techniques used to facilitate oral motor skills for drinking, eating, and swallowing. Examples include hand-to-mouth patterns; mastication; adaptive utensils; positioning at mealtime.
    • Task 2 knowledge 8: Prevocational, vocational, and transitional services, options, and resources for supporting strengths, interests, employment, and lifestyle goals across the life span.
    • Task 2 knowledge 9: Strategies, techniques, and client-centered education to facilitate functional transfers.
    • Task 2 knowledge 10: Strategies for promoting wellness and mental health. Examples include relaxation; sleep hygiene; addiction management.
    • Task 3: Select and implement interventions for improving sensory, motor, neurological, and physiological status, considering client condition and current stage of recovery, to support occupational performance.
    • Task 3 knowledge 1: Methods for grading therapeutic exercise and conditioning programs consistent with indications and precautions.
    • Task 3 knowledge 2: Techniques for sensory and motor reeducation, pain management, desensitization, edema reduction, and scar management. Examples include manual edema mobilization; nerve gliding; neuromuscular reeducation; constraint-induced movement.
    • Task 3 knowledge 3: Techniques for promoting improved postural stability, dynamic balance, body mechanics, and breathing patterns during functional tasks.
    • Task 4: Select, fabricate, and modify orthotic devices, and provide training in the use of orthotic and prosthetic devices to support functional outcomes.
    • Task 4 knowledge 1: Types and functions of immobilization, mobilization, and restriction orthoses for managing specific conditions and congenital anomalies across the life span.
    • Task 4 knowledge 2: Types and functions of prosthetic devices for upper and lower extremity amputations.
    • Task 4 knowledge 3: Implications of anatomical, physiological, biomechanical, cognitive, and socioeconomic factors and healing principles for orthotic selection, design, fabrication, and modification.
    • Task 4 knowledge 4: Client-centered education and training methods for the safe and effective use of orthotic and prosthetic devices.
    • Task 5: Select assistive technology options, adaptive devices, mobility aids, and other durable medical equipment to enable participation in occupation.
    • Task 5 knowledge 1: Factors related to measuring, selecting, monitoring the fit of, and recommending modifications to seating systems, positioning devices, and mobility aids. Examples include equipment components; biomechanical considerations; usability and maintenance.
    • Task 5 knowledge 2: Types, characteristics, and features of high- and low-tech assistive technology and adaptive devices. Examples include interface options and processor parameters; equipment components.
    • Task 5 knowledge 3: Mobility options, vehicle adaptations, and alternative devices for supporting participation in community mobility. Examples include adapted driving controls; wheelchair tie downs; alternative transportation options; dynamic mobile standers; navigation apps.
    • Task 5 knowledge 4: Client factors influencing successful use and maintenance of assistive technology options, adaptive devices, mobility aids, and other durable medical equipment. Examples include developmental, physical, functional, cognitive, and mental health status; prioritized needs.
    • Task 5 knowledge 5: Client-centered education and training methods for successful use and maintenance of assistive technology options, adaptive devices, mobility aids, and other durable medical equipment.
    • Task 6: Recommend environmental modifications, while considering accessibility guidelines, standards, and legislation, to support participation in occupation consistent with client needs and status, task demands, and context.
    • Task 6 knowledge 1: Principles of ergonomics and universal design for identifying, recommending, and implementing features and reasonable accommodations in the workplace, home, and virtual and public spaces.
    • Task 6 knowledge 2: Processes and procedures for identifying, recommending, and implementing modifications in the workplace, home, and virtual and public spaces.
  • Domain 4 — Competency and Practice Management: Manage professional activities of self and relevant others as guided by evidence, regulatory compliance, and standards of practice to promote quality care. (16%)
    • Task 1: Employ evidence-based strategies and approaches to provide safe, effective, and efficient services relevant to individuals, groups, and populations.
    • Task 1 knowledge 1: Methods for locating, reviewing, interpreting, and critically appraising scholarly research to guide practice-relevant decision-making. Examples include defining a clinical question; determining the clinical bottom line.
    • Task 1 knowledge 2: Methods for applying continuous quality improvement processes and procedures to occupational therapy service delivery. Examples include program evaluation; outcome measures.
    • Task 1 knowledge 3: Evidence-based programming for advancing population health outcomes. Examples include aging in place; fall prevention; health and wellness; community support groups.
    • Task 2: Incorporate risk management techniques at the individual and practice-setting levels to protect clients, self, staff, and others from injury or harm.
    • Task 2 knowledge 1: Infection control procedures and universal precautions for reducing transmission of contaminants. Examples include PPE; isolation precautions; cleaning equipment.
    • Task 2 knowledge 2: Responses to adverse reactions, minor injuries, and emergency situations. Examples include minor burns and cuts; seizures; diabetic reactions.
    • Task 2 knowledge 3: Preventive measures for minimizing risk and promoting safety. Examples include proper body mechanics; safety data sheet (SDS); standard operating procedures; equipment maintenance; emergency preparedness; personal safety in the client’s environment.
    • Task 2 knowledge 4: Strategies and resources to prevent professional burnout. Examples include assessment of personal needs; self-advocacy regarding workload; stress management.
    • Task 3: Provide occupational therapy services in accordance with laws, regulations, state occupational therapy practice acts, and accreditation guidelines to protect consumers and meet applicable reimbursement requirements related to the service delivery setting.
    • Task 3 knowledge 1: Application of federal regulations, state practice acts, facility policies, and accreditation guidelines related to service delivery across occupational therapy practice settings. Examples include health care legislation; accreditation organizations; licensing and credentialing; supervisory role under state practice acts.
    • Task 3 knowledge 2: Influence of reimbursement policies and guidelines on occupational therapy service delivery.
    • Task 3 knowledge 3: Accountability processes and procedures for justifying, tracking, and monitoring outcomes. Examples include relevant practice terminology; documentation guidelines.
    • Task 4: Engage in professional development and competency assessment activities relevant to the job role, practice setting, scope of practice, and professional certification standards.
    • Task 4 knowledge 1: Methods for identifying, documenting, and monitoring service competency and professional development needs. Examples include competency self-assessment; mentoring.
    • Task 4 knowledge 2: Application of ethical decision-making and professional behaviors guided by the NBCOT Practice Standards and Code of Conduct.
Examination sources

COTA Certification Exam

Format
Three- and four-option single-response multiple-choice items and six-option multi-select items
Exam questions
190 items
Examination outline
  • Domain 1 — Collaborate and Gather Information: Under the supervision of the OTR, acquire information on an ongoing basis regarding factors that influence occupational performance. (27%)
    • Task 1: Recognize the influence of development and lived experience; body functions and body structures; values, beliefs, and spirituality; and identity on occupational performance.
    • Task 1 knowledge 1: Impact of typical development and aging on occupational performance, health, and wellness across the life span.
    • Task 1 knowledge 2: Expected patterns, progressions, and prognoses associated with conditions that limit occupational performance. Examples include signs and symptoms of disease; stages of disease; secondary complications.
    • Task 1 knowledge 3: Impact of body functions and body structures on occupational performance. Examples include cognitive impairments; congenital anomalies.
    • Task 1 knowledge 4: Influence of lived experiences and identity on occupational performance. Examples include history of trauma and adverse childhood events; socioeconomic status; gender, race, culture, religion.
    • Task 2: Acquire information about a client’s functional skills, roles, prioritized needs and wants, and performance context to inform the development of and updates to an occupational profile.
    • Task 2 knowledge 1: Resources for acquiring information about the client’s current condition and occupational performance. Examples include referrals; client records; developmental history; Individualized Education Program (IEP) plans.
    • Task 2 knowledge 2: Purpose, advantages, limitations, and service competency needs related to the administration of standardized and nonstandardized assessments and screening methods. Examples include criterion-referenced tests; norm-referenced tests; client and caregiver interviews; observation.
    • Task 2 knowledge 3: Internal and external factors influencing a client’s engagement in occupation. Examples include roles, habits, routines, and rituals; environmental context; family and social supports; medication side effects and interactions; mental health.
    • Task 3: Perform an activity analysis to determine the influence of task demands, current conditions, performance skills, and context on occupation.
    • Task 3 knowledge 1: Task requirements, steps to task completion, and task demands across contexts or settings.
    • Task 3 knowledge 2: Personal and environmental factors that facilitate or inhibit task completion or occupational engagement. Examples include compensation patterns; role of performance context; influence of current conditions.
    • Task 4: Collaborate with the client, the client’s relevant others, occupational therapy colleagues, and other professionals using a client-centered approach and therapeutic use of self to provide quality occupational therapy services.
    • Task 4 knowledge 1: Roles and responsibilities among interprofessional teams when coordinating client care and providing services. Examples include referral to and consultation with other services; interprofessional communication methods; scope of practice.
    • Task 4 knowledge 2: Processes for supporting interprofessional intervention plans. Examples include Individualized Education Program (IEP) plans; discharge plans; transition plans; palliative and hospice care plans.
    • Task 4 knowledge 3: Client-centered approaches and considerations for coordinating occupational therapy services. Examples include therapeutic use of self; advocacy; frequency/duration of intervention; level of service delivery.
    • Task 4 knowledge 4: Factors used to prioritize intervention goals and activities in collaboration with the client and family, teacher, caregiver, and relevant others. Examples include client-reported outcomes; level of support required; context of service delivery; progress toward goals.
    • Task 4 knowledge 5: Strategies for addressing and enhancing health literacy with the client and relevant others. Examples include caregiver training; teaching-learning models; methods for making health information accessible; informed decision-making; navigating challenges to professional expertise.
    • Task 5: Monitor the intervention plan, approach, context, and goals on an ongoing basis, in collaboration with the OTR, using clinical reasoning.
    • Task 5 knowledge 1: Factors for determining and managing context and activities to meet individual and group intervention goals and objectives. Examples include client needs and priorities; response to intervention.
    • Task 5 knowledge 2: Strategies for monitoring the effectiveness of individual and group intervention. Examples include client-reported outcomes; reevaluation results; progress toward goals.
    • Task 5 knowledge 3: Clinical decision-making for prioritizing goals and implementing modifications to the intervention plan based on client responses, under the supervision of the OTR. Examples include physiological changes; behavioral reactions; emotion regulation; developmental needs.
    • Task 5 knowledge 4: Precautions or contraindications associated with a client condition or stage of recovery. Examples include postsurgical precautions; vital signs; laboratory values; suicidal ideation.
  • Domain 2 — Select and Implement Interventions: Implement interventions, under the supervision of the OTR, in accordance with the intervention plan and level of service competence to support client participation in areas of occupation throughout the occupational therapy process. (55%)
    • Task 1: Incorporate preparatory techniques, activities, and modalities as an adjunct to interventions to promote healing and enhance engagement in occupation-based activities.
    • Task 1 knowledge 1: Considerations for selecting, preparing, and adapting the intervention technique to support optimal engagement and promote goal achievement. Examples include client condition; client safety; theoretical approach and frame of reference.
    • Task 1 knowledge 2: Considerations for selecting, preparing, and adapting the intervention environment to support optimal engagement and promote goal achievement. Examples include ensuring privacy during telehealth sessions; equipment safety; line management.
    • Task 1 knowledge 3: Indications, contraindications, and precautions associated with wounds and maintaining skin integrity. Examples include stage of wound healing; prevention and management of pressure ulcers.
    • Task 1 knowledge 4: Indications, contraindications, precautions, and clinical application of superficial thermal agents. Examples include dry whirlpool; hot packs; cryotherapy.
    • Task 1 knowledge 5: Indications, contraindications, precautions, and clinical application of deep thermal, mechanical, and electrotherapeutic physical agent modalities. Examples include transcutaneous and neuromuscular electrical stimulation; biofeedback.
    • Task 2: Implement occupation-based strategies to support participation in activities of daily living (ADL), instrumental activities of daily living (IADL), health management, rest and sleep, education, work, play, leisure, and social participation across the life span.
    • Task 2 knowledge 1: Interventions for supporting leisure and play.
    • Task 2 knowledge 2: Methods for grading an activity, task, or technique based on level of development, client status, response to intervention, and client needs.
    • Task 2 knowledge 3: Considerations for facilitating individual and group participation in shared activities. Examples include group processes; group dynamics; group type and function.
    • Task 2 knowledge 4: Interventions to support cognitive, visual-motor, visual, and perceptual processing and sensory arousal. Examples include sensory modulation; proprioceptive input; vestibular strategies; low vision strategies.
    • Task 2 knowledge 5: Compensatory and remedial strategies for managing cognitive and perceptual deficits or developmental disabilities. Examples include graded cueing; chaining; metacognition; memory aids.
    • Task 2 knowledge 6: Adaptive and preventive strategies for supporting optimal engagement in occupation. Examples include use of technology/apps; joint protection; task simplification; energy conservation.
    • Task 2 knowledge 7: Intervention strategies and techniques used to facilitate oral motor skills for drinking, eating, and swallowing. Examples include hand-to-mouth patterns; mastication; adaptive utensils; positioning at mealtime.
    • Task 2 knowledge 8: Prevocational, vocational, and transitional services, options, and resources for supporting strengths, interests, employment, and lifestyle goals across the life span.
    • Task 2 knowledge 9: Strategies, techniques, and client-centered education to facilitate functional transfers.
    • Task 2 knowledge 10: Strategies for promoting wellness and mental health. Examples include relaxation; sleep hygiene; addiction management.
    • Task 3: Implement interventions for improving sensory, motor, neurological, and physiological status, considering client condition and current stage of recovery, to support occupational performance.
    • Task 3 knowledge 1: Methods for grading therapeutic exercise and conditioning programs consistent with indications and precautions.
    • Task 3 knowledge 2: Techniques for sensory and motor reeducation, pain management, desensitization, edema reduction, and scar management. Examples include manual edema mobilization; nerve gliding; neuromuscular reeducation; constraint-induced movement.
    • Task 3 knowledge 3: Techniques for promoting improved postural stability, dynamic balance, body mechanics, and breathing patterns during functional tasks.
    • Task 4: Select, fabricate, and modify orthotic devices, and provide training in the use of orthotic and prosthetic devices in order to support functional outcomes.
    • Task 4 knowledge 1: Types and functions of immobilization, mobilization, and restriction orthoses for managing specific conditions and congenital anomalies across the life span.
    • Task 4 knowledge 2: Types and functions of prosthetic devices for upper and lower extremity amputations.
    • Task 4 knowledge 3: Implications of anatomical, physiological, biomechanical, cognitive, and socioeconomic factors and healing principles for orthotic selection, design, fabrication, and modification.
    • Task 4 knowledge 4: Client-centered education and training methods for the safe and effective use of orthotic and prosthetic devices.
    • Task 5: Integrate assistive technology options, adaptive devices, mobility aids, and other durable medical equipment into the intervention to enable participation in occupation.
    • Task 5 knowledge 1: Factors related to measuring, selecting, monitoring the fit of, and recommending modifications to seating systems, positioning devices, and mobility aids. Examples include equipment components; biomechanical considerations; usability and maintenance.
    • Task 5 knowledge 2: Types, characteristics, and features of high- and low-tech assistive technology and adaptive devices. Examples include interface options and processor parameters; equipment components.
    • Task 5 knowledge 3: Mobility options, vehicle adaptations, and alternative devices for supporting participation in community mobility. Examples include adapted driving controls; wheelchair tie downs; alternative transportation options; dynamic mobile standers; navigation apps.
    • Task 5 knowledge 4: Client factors influencing successful use and maintenance of assistive technology options, adaptive devices, mobility aids, and other durable medical equipment. Examples include developmental, physical, functional, cognitive, and mental health status; prioritized needs.
    • Task 5 knowledge 5: Client-centered education and training methods for successful use and maintenance of assistive technology options, adaptive devices, mobility aids, and other durable medical equipment.
    • Task 6: Implement environmental modifications, while considering accessibility guidelines, standards, and legislation, to support participation in occupation consistent with client needs and status, task demands, and context.
    • Task 6 knowledge 1: Principles of ergonomics and universal design for identifying, recommending, and implementing features and reasonable accommodations in the workplace, home, and virtual and public spaces.
    • Task 6 knowledge 2: Processes and procedures for identifying, recommending, and implementing modifications in the workplace, home, and virtual and public spaces.
  • Domain 3 — Uphold Professional Standards and Responsibilities: Uphold professional standards and responsibilities by achieving service competence and applying evidence-based interventions to promote quality in practice. (18%)
    • Task 1: Employ evidence-based strategies and approaches to provide safe, effective, and efficient services relevant to individuals, groups, and populations.
    • Task 1 knowledge 1: Methods for locating, reviewing, and interpreting scholarly research to guide practice-relevant decision-making. Examples include applying the Patient, Intervention, Comparison, Outcome (PICO) model; identifying best evidence.
    • Task 1 knowledge 2: Methods for contributing to continuous quality improvement processes and procedures related to occupational therapy service delivery. Examples include program evaluation; acquiring information to measure outcomes.
    • Task 1 knowledge 3: Types of evidence-based programming for advancing population health outcomes. Examples include aging in place; fall prevention; health and wellness; community support groups.
    • Task 2: Incorporate risk management techniques at the individual and practice-setting levels to protect clients, self, staff, and others from injury or harm.
    • Task 2 knowledge 1: Infection control procedures and universal precautions for reducing transmission of contaminants. Examples include PPE; isolation precautions; cleaning equipment.
    • Task 2 knowledge 2: Responses to adverse reactions, minor injuries, and emergency situations. Examples include minor burns and cuts; seizures; diabetic reactions.
    • Task 2 knowledge 3: Preventive measures for minimizing risk and promoting safety. Examples include proper body mechanics; safety data sheet (SDS); standard operating procedures; equipment maintenance; emergency preparedness; personal safety in the client’s environment.
    • Task 2 knowledge 4: Strategies and resources to prevent professional burnout. Examples include assessment of personal needs; self-advocacy regarding workload; stress management.
    • Task 3: Provide occupational therapy services in accordance with laws, regulations, state occupational therapy practice acts, and accreditation guidelines to protect consumers and meet applicable reimbursement requirements related to the service delivery setting.
    • Task 3 knowledge 1: Application of federal regulations, state practice acts, facility policies, and accreditation guidelines related to service delivery across occupational therapy practice settings. Examples include health care legislation; accreditation organizations; licensing and credentialing.
    • Task 3 knowledge 2: Influence of reimbursement policies and guidelines on occupational therapy service delivery.
    • Task 3 knowledge 3: Accountability processes and procedures for justifying, tracking, and monitoring outcomes. Examples include relevant practice terminology; documentation guidelines.
    • Task 4: Engage in professional development and competency assessment activities relevant to the job role, practice setting, scope of practice, and professional certification standards.
    • Task 4 knowledge 1: Methods for identifying, documenting, and monitoring service competency and professional development needs. Examples include competency self-assessment; mentoring.
    • Task 4 knowledge 2: Application of ethical decision-making and professional behaviors guided by the NBCOT Practice Standards and Code of Conduct.
Examination sources