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Pennsylvania Occupational Therapy — Requirements & Free Practice

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Occupational Therapist License

License to practice occupational therapy in Pennsylvania issued by the State Board of Occupational Therapy Education and Licensure.

Licensing authority: State Board of Occupational Therapy Education and Licensure · Application information

Biennial renewal
No examination is required for this applicant pathway.
Nbcot Certification
Maintenance of NBCOT certification is not necessary for renewal (Board FAQ).
Professional Liability Insurance
Certify maintenance of the required professional liability insurance (49 Pa. Code § 42.16(c)(1)).
Renewal
Biennial renewal application and fee, continued competency (24 contact hours) under 49 Pa. Code § 42.53, and 2 hours of approved child abuse recognition and reporting continuing education (49 Pa. Code § 42.16(c)).

Official no-examination sources

Effective from 2023-11-04.

Licensure by endorsement
OTR exam
Child Abuse Training
3 hours of child abuse recognition and reporting training from a DHS-approved provider (49 Pa. Code § 42.9(a)(8)).
Discipline
No act constituting grounds for refusal, suspension or revocation and no discipline by the issuing jurisdiction, unless the Board in its discretion determines otherwise (49 Pa. Code § 42.9(a)(3), (a)(4), (c)).
Examination Basis
49 Pa. Code § 42.9(a)(1) measures the other jurisdiction against § 42.11 (the NBCOT licensure examination), and the Board FAQ states "Applicants must demonstrate passing the NBCOT certification examination for initial licensure".
Experience
Active licensed practice for at least 2 of the 5 years immediately preceding the application (49 Pa. Code § 42.9(a)(2)).
Interview
The Board may require a personal interview and additional information (49 Pa. Code § 42.9(b)).
Out Of State License
Current license, certificate, registration or permit in good standing as an occupational therapist in another jurisdiction whose standards are substantially equivalent to or exceed Practice Act § 8 and 49 Pa. Code §§ 42.11 and 42.13(a), with a copy of that jurisdiction's law including its enactment date (63 Pa.C.S. § 3111(a)(1); 49 Pa. Code § 42.9(a)(1)).
Professional Liability Insurance
Professional liability requirements of Practice Act § 8 and 49 Pa. Code § 42.13(b) (49 Pa. Code § 42.9(a)(6)).
Licensure by examination
OTR exam
Child Abuse Training
3 hours of approved training in child abuse recognition and reporting (49 Pa. Code §§ 42.13(a)(5), 42.48(a)), unless an exemption under § 42.48(c) is granted.
Education
Completion of an approved occupational therapist educational program: four-year program (or Board-approved equivalent) accredited by ACOTE or predecessor organizations, or approved by the Board and accredited by a USDE-recognized programmatic accreditor (Practice Act § 8(2); 49 Pa. Code § 42.13(a)(2)).
Exam Retakes
49 Pa. Code § 42.11(e): after a second or successive failure the Board may require additional Board-approved training.
Fieldwork
6 months of supervised fieldwork as part of the accredited educational program (Practice Act § 8(3); 49 Pa. Code § 42.13(a)(3)).
Good Moral Character
Applicant must be of good moral character (Practice Act § 8(1); 49 Pa. Code § 42.13(a)(1)).
Nbcot Certification Waiver
49 Pa. Code § 42.12(2): an applicant who has successfully completed the NBCOT Certification Examination and is currently certified by NBCOT may be licensed without examination; the passed NBCOT examination is the same examination this route requires.
Professional Liability Insurance
Proof of professional liability insurance of at least $1,000,000 per occurrence or claims made, an insurer letter, or an employer-coverage certification (Practice Act § 8(5); 49 Pa. Code § 42.13(b)).
Foreign educated licensure by examination
OTR exam
Child Abuse Training
3 hours of approved training in child abuse recognition and reporting (49 Pa. Code §§ 42.13(a)(5), 42.48(a)), unless an exemption under § 42.48(c) is granted.
Education Equivalence
Educational requirements substantially equal to 49 Pa. Code § 42.13(2); the Board accepts an NBCOT credentials evaluation as proof (49 Pa. Code § 42.14(a)(2)).
Examination Waiver
Alternatively qualifies for a waiver of the licensure examination under 49 Pa. Code § 42.12 (49 Pa. Code § 42.14(b)(2)).
Foreign Education
Professional education completed outside the United States, its territories, the District of Columbia or Canada (Practice Act §§ 3, 10).
Good Moral Character
Applicant must be of good moral character (Practice Act § 8(1); 49 Pa. Code § 42.13(a)(1)).
Professional Liability Insurance
Proof of professional liability insurance of at least $1,000,000 per occurrence or claims made, an insurer letter, or an employer-coverage certification (Practice Act § 8(5); 49 Pa. Code § 42.13(b)).
Supervised Fieldwork
The Board may, at its discretion, require not more than one year of supervised fieldwork before the examination (Practice Act § 10).
Reactivation of expired or inactive license
OTR exam
Additional Board Requirements
The Board may require a personal interview, an oral practical examination (not otherwise identified), or proof of physical and mental fitness (49 Pa. Code § 42.16(i)(1)-(3)).
Examination Waiver
Alternatively qualifies for a waiver of examination under 49 Pa. Code § 42.12 (49 Pa. Code § 42.16(i)).
Reactivation Submissions
Sworn statement of the period not in practice, resume of professional activities, letter of good standing where applicable, 2 hours of child abuse recognition and reporting continuing education, and fees, plus proof of professional liability insurance (49 Pa. Code § 42.16(g)).
When Exam Applies
The licensure examination applies only when the license has been expired more than four years (Practice Act § 15(a)) or the applicant has not practiced for longer than 4 years (49 Pa. Code § 42.16(i)); the Board FAQ applies it when the license has been inactive/expired 4 years or more and the licensee has not practiced in another state in the last 4 years. A licensee returning earlier reactivates without the examination.
License without examination licensed elsewhere
No examination is required for this applicant pathway.
Board Faq Statement
Lower-ranked Board FAQ (Resources and Documents): "No. Applicants must demonstrate passing the NBCOT certification examination for initial licensure, but maintenance of certification is not necessary for renewal." Practice Act § 12 provides that the Board "shall issue a license without examination" to this applicant, so the route carries no examination leaf; the Board may still ask for proof of the NBCOT examination.
Other State License
Licensed or registered as an occupational therapist in another state, territory of the United States or the District of Columbia whose requirements are substantially equivalent to those of the Commonwealth (Practice Act § 12(2); 49 Pa. Code § 42.12(1)).

Official no-examination sources

Effective from 2023-11-04.

Occupational Therapy Assistant License

License to assist in the practice of occupational therapy under the supervision of an occupational therapist in Pennsylvania.

Licensing authority: State Board of Occupational Therapy Education and Licensure · Application information

Biennial renewal
No examination is required for this applicant pathway.
Nbcot Certification
Maintenance of NBCOT certification is not necessary for renewal (Board FAQ).
Renewal
Biennial renewal application and fee, continued competency (24 contact hours) under 49 Pa. Code § 42.53, and 2 hours of approved child abuse recognition and reporting continuing education (49 Pa. Code § 42.16(c)).

Official no-examination sources

Effective from 2023-11-04.

Licensure by endorsement
COTA Certification Exam
Child Abuse Training
3 hours of child abuse recognition and reporting training from a DHS-approved provider (49 Pa. Code § 42.9(a)(8)).
Discipline
No act constituting grounds for refusal, suspension or revocation and no discipline by the issuing jurisdiction, unless the Board in its discretion determines otherwise (49 Pa. Code § 42.9(a)(3), (a)(4), (c)).
Examination Basis
49 Pa. Code § 42.9(a)(1) measures the other jurisdiction against § 42.11 (the NBCOT licensure examination), and the Board FAQ states "Applicants must demonstrate passing the NBCOT certification examination for initial licensure".
Experience
Active licensed practice for at least 2 of the 5 years immediately preceding the application (49 Pa. Code § 42.9(a)(2)).
Interview
The Board may require a personal interview and additional information (49 Pa. Code § 42.9(b)).
Out Of State License
Current license, certificate, registration or permit in good standing as an occupational therapy assistant in another jurisdiction whose standards are substantially equivalent to or exceed Practice Act § 8 and 49 Pa. Code §§ 42.11 and 42.13(a), with a copy of that jurisdiction's law including its enactment date (63 Pa.C.S. § 3111(a)(1); 49 Pa. Code § 42.9(a)(1)).
Licensure by examination
COTA Certification Exam
Child Abuse Training
3 hours of approved training in child abuse recognition and reporting (49 Pa. Code §§ 42.13(a)(5), 42.48(a)), unless an exemption under § 42.48(c) is granted.
Education
Completion of an approved occupational therapy assistant educational program: two-year program (or Board-approved equivalent) accredited by ACOTE or predecessor organizations, or approved by the Board and accredited by a USDE-recognized programmatic accreditor (Practice Act § 8(2); 49 Pa. Code § 42.13(a)(2)).
Exam Retakes
49 Pa. Code § 42.11(e): after a second or successive failure the Board may require additional Board-approved training.
Fieldwork
2 months of supervised fieldwork as part of the accredited educational program (Practice Act § 8(3); 49 Pa. Code § 42.13(a)(3)).
Good Moral Character
Applicant must be of good moral character (Practice Act § 8(1); 49 Pa. Code § 42.13(a)(1)).
Nbcot Certification Waiver
49 Pa. Code § 42.12(2): an applicant who has successfully completed the NBCOT Certification Examination and is currently certified by NBCOT may be licensed without examination; the passed NBCOT examination is the same examination this route requires.
Foreign educated licensure by examination
COTA Certification Exam
Child Abuse Training
3 hours of approved training in child abuse recognition and reporting (49 Pa. Code §§ 42.13(a)(5), 42.48(a)), unless an exemption under § 42.48(c) is granted.
Education Equivalence
Educational requirements substantially equal to 49 Pa. Code § 42.13(2); the Board accepts an NBCOT credentials evaluation as proof (49 Pa. Code § 42.14(a)(2)).
Examination Waiver
Alternatively qualifies for a waiver of the licensure examination under 49 Pa. Code § 42.12 (49 Pa. Code § 42.14(b)(2)).
Foreign Education
Professional education completed outside the United States, its territories, the District of Columbia or Canada (Practice Act §§ 3, 10).
Good Moral Character
Applicant must be of good moral character (Practice Act § 8(1); 49 Pa. Code § 42.13(a)(1)).
Supervised Fieldwork
The Board may, at its discretion, require not more than one year of supervised fieldwork before the examination (Practice Act § 10).
Reactivation of expired or inactive license
COTA Certification Exam
Additional Board Requirements
The Board may require a personal interview, an oral practical examination (not otherwise identified), or proof of physical and mental fitness (49 Pa. Code § 42.16(i)(1)-(3)).
Examination Waiver
Alternatively qualifies for a waiver of examination under 49 Pa. Code § 42.12 (49 Pa. Code § 42.16(i)).
Reactivation Submissions
Sworn statement of the period not in practice, resume of professional activities, letter of good standing where applicable, 2 hours of child abuse recognition and reporting continuing education, and fees (49 Pa. Code § 42.16(g)).
When Exam Applies
The licensure examination applies only when the license has been expired more than four years (Practice Act § 15(a)) or the applicant has not practiced for longer than 4 years (49 Pa. Code § 42.16(i)); the Board FAQ applies it when the license has been inactive/expired 4 years or more and the licensee has not practiced in another state in the last 4 years. A licensee returning earlier reactivates without the examination.
License without examination licensed elsewhere
No examination is required for this applicant pathway.
Board Faq Statement
Lower-ranked Board FAQ (Resources and Documents): "No. Applicants must demonstrate passing the NBCOT certification examination for initial licensure, but maintenance of certification is not necessary for renewal." Practice Act § 12 provides that the Board "shall issue a license without examination" to this applicant, so the route carries no examination leaf; the Board may still ask for proof of the NBCOT examination.
Other State License
Licensed or registered as an occupational therapy assistant in another state, territory of the United States or the District of Columbia whose requirements are substantially equivalent to those of the Commonwealth (Practice Act § 12(2); 49 Pa. Code § 42.12(1)).

Official no-examination sources

Effective from 2023-11-04.

Provisional Endorsement License (Occupational Therapist or Occupational Therapy Assistant)

Provisional endorsement license the Board may issue under 63 Pa.C.S. § 3111(b) and 49 Pa. Code § 42.10 while an endorsement applicant satisfies remaining requirements.

Licensing authority: State Board of Occupational Therapy Education and Licensure · Application information

Provisional endorsement license

At least one of the following alternatives:

Discipline
Occupational therapist applicants rely on the OTR examination and occupational therapy assistant applicants on the COTA examination, matching the license applied for by endorsement under 49 Pa. Code § 42.9.
Endorsement Applicant
Applicant for licensure by endorsement under 63 Pa.C.S. § 3111 and 49 Pa. Code § 42.9 who is satisfying remaining requirements; issuance is at the Board's discretion (49 Pa. Code § 42.10(a)).
Term
Practice for up to 1 year after issuance, extendable once by up to 1 year for good cause; no subsequent provisional endorsement license (49 Pa. Code § 42.10(b)-(d)).

Temporary Occupational Therapist License

Temporary license under section 9 of the Occupational Therapy Practice Act and 49 Pa. Code § 42.15 for occupational therapist applicants.

Licensing authority: State Board of Occupational Therapy Education and Licensure · Application information

Temporary license examination candidate
OTR exam
Child Abuse Training
3 hours of approved child abuse recognition and reporting training (49 Pa. Code §§ 42.13(a)(5), 42.15(e)).
Examination Status
Eligible and applied to take the licensure examination, or failed it once and applied to retake it on the next scheduled date; the temporary license expires on failure to sit the examination (absent an approved excuse) or on notice of failing the re-examination (49 Pa. Code § 42.15(a)(2)).
Licensure Requirements
Has met the requirements for licensure under 49 Pa. Code § 42.13 (49 Pa. Code § 42.15(a)(1)).
Professional Liability Insurance
Professional liability insurance proof, insurer letter, or employer-coverage certification (49 Pa. Code § 42.15(d)).
Scope Of Practice
Practice only as an assistant under the direct supervision of a licensed occupational therapist (49 Pa. Code § 42.15(b)).
Temporary license nonresident
OTR exam
Certification Basis
Practice Act § 9(b)(2) still names certification established by the American Occupational Therapy Association; the current rule, 49 Pa. Code § 42.15(c)(3), names certification established by NBCOT, whose certification examination is the leaf.
Duration And Association
Services for not longer than 6 consecutive months in a calendar year, in association with a Pennsylvania-licensed occupational therapist (49 Pa. Code § 42.15(c)(4)).
License Alternative
Instead of meeting NBCOT certification requirements, the applicant may be licensed as an occupational therapist in the District of Columbia or a state or territory with substantially equal licensure requirements (49 Pa. Code § 42.15(c)(3); Practice Act § 9(b)(1)).
Professional Liability Insurance
Professional liability insurance proof, insurer letter, or employer-coverage certification (49 Pa. Code § 42.15(d)).
Residency
Not a resident of and not licensed in the Commonwealth (49 Pa. Code § 42.15(c)(2)).

Temporary Occupational Therapy Assistant License

Temporary license under section 9 of the Occupational Therapy Practice Act and 49 Pa. Code § 42.15 for occupational therapy assistant applicants.

Licensing authority: State Board of Occupational Therapy Education and Licensure · Application information

Temporary license examination candidate
COTA Certification Exam
Child Abuse Training
3 hours of approved child abuse recognition and reporting training (49 Pa. Code §§ 42.13(a)(5), 42.15(e)).
Examination Status
Eligible and applied to take the licensure examination, or failed it once and applied to retake it on the next scheduled date; the temporary license expires on failure to sit the examination (absent an approved excuse) or on notice of failing the re-examination (49 Pa. Code § 42.15(a)(2)).
Licensure Requirements
Has met the requirements for licensure under 49 Pa. Code § 42.13 (49 Pa. Code § 42.15(a)(1)).
Scope Of Practice
Practice only as an assistant under the direct supervision of a licensed occupational therapist (49 Pa. Code § 42.15(b)).
Temporary license nonresident
COTA Certification Exam
Certification Basis
Practice Act § 9(b)(2) still names certification established by the American Occupational Therapy Association; the current rule, 49 Pa. Code § 42.15(c)(3), names certification established by NBCOT, whose certification examination is the leaf.
Duration And Association
Services for not longer than 6 consecutive months in a calendar year, in association with a Pennsylvania-licensed occupational therapist (49 Pa. Code § 42.15(c)(4)).
License Alternative
Instead of meeting NBCOT certification requirements, the applicant may be licensed as an occupational therapy assistant in the District of Columbia or a state or territory with substantially equal licensure requirements (49 Pa. Code § 42.15(c)(3); Practice Act § 9(b)(1)).
Residency
Not a resident of and not licensed in the Commonwealth (49 Pa. Code § 42.15(c)(2)).

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