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Tennessee Occupational Therapy — Requirements & Free Practice

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Licenses, application pathways and examination requirements

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Occupational Therapist License

Tennessee license to practice as an occupational therapist, issued by the Board of Occupational Therapy by examination or by reciprocity.

Licensing authority: Tennessee Board of Occupational Therapy

Licensure by examination
OTR exam
Education
Successful completion of the academic requirements of an ACOTE-accredited (or predecessor) educational program for occupational therapists; graduate transcript sent directly from the degree-granting institution (Rule 1150-02-.04 and .05(1)(f)).
Examination Older Than Three Years
If the application is more than three years after successful completion of the NBCOT examination and the applicant is not applying by reciprocity, the Board may impose additional requirements such as self-assessment, formal learning hours, continuing education in ethics, Tennessee jurisprudence and documentation, and twelve months of supervised practice (Rule 1150-02-.04(3)).
Examination Timing
An application is abandoned if the applicant fails to sit for the written exam within 12 months after being notified of eligibility (Rule 1150-02-.07(8)(a)2).
Fieldwork
Successful completion of the supervised fieldwork experience required by ACOTE (Rule 1150-02-.04).
Good Moral Character
Be of good moral character; submit an original letter of recommendation attesting to good moral character that is not from a relative (Rule 1150-02-.04 and .05(1)(g)).
Internationally Trained
Applicants educated outside the United States must also furnish proof of compliance with T.C.A. § 63-13-214, which requires them to satisfy the examination requirements of § 63-13-202(b) and to show education and fieldwork substantially equal to those required (Rule 1150-02-.04(5)).
Other Documents
Application and fees, passport-style photograph, criminal background check, disclosure of convictions, discipline and civil judgments, Declaration of Citizenship, and English translations where needed (Rule 1150-02-.05(1); Application Instructions PH-3123).
Statutory Alternative Eligibility
Rule 1150-02-.04 also accepts an applicant who is eligible for licensure as provided in T.C.A. § 63-13-213; the Board decides that eligibility.
Reactivation of retired or inactive license
No examination is required for this applicant pathway.
Board Discretion
If the license has been expired or retired for more than three years, the Board may, at its discretion, require additional education, supervised clinical practice, or successful passage of examinations (Rule 1150-02-.12(14)(b)2); no rule identifies such an examination.
Continued Competence
Completion of continued competence requirements for the two-year period preceding the reactivation year (Rule 1150-02-.11(3)(c) and .12(14)).
Fees
Licensure renewal fees and state regulatory fee; late renewal fee and past due renewal fees if reactivation is requested within one year of retirement (Rule 1150-02-.11(3)(b)).
Request
Written request for licensure reactivation to the Board administrative office (Rule 1150-02-.11(3)(a)).
Status
The applicant holds a Tennessee license in retired or inactive status (Rule 1150-02-.11(1)).

Official no-examination sources

Effective from 2026-06-21.

Licensure by reciprocity
OTR exam
Current Licensure Elsewhere
Proof of current licensure or certification as an occupational therapist in another state, the District of Columbia or a U.S. territory, with verification of licensure status sent directly from every state in which the applicant is or has been licensed (Rule 1150-02-.05(2)(a) and (h)).
Examination Verification
The applicant must have NBCOT send certification examination results directly to the Board (Rule 1150-02-.05(2)(i)). The Board application instructions state: "Reciprocity applicants must have NBCOT submit verification of certification or licensure."
Other Documents
Application and fees, passport-style photograph, criminal background check, disclosure of convictions, discipline and civil judgments, and English translations where needed (Rule 1150-02-.05(2)).
Qualifications
Educational and experiential qualifications that meet or exceed Tennessee requirements, as determined by the Board (Rule 1150-02-.05(2)(a)); graduate transcript from an AOTA-accredited degree-granting institution (Rule 1150-02-.05(2)(g)).
Statutory Waiver
T.C.A. § 63-13-213(2) (text enacted by Public Chapter 415 of 1999) permits the Board to waive the examination, education or experience requirements for an applicant currently licensed or certified in another jurisdiction whose qualifications exceed those required in Tennessee; the Board rule for reciprocity applicants requires NBCOT examination verification.
Reinstatement of expired license
No examination is required for this applicant pathway.
Board Discretion
If the license has been expired or retired for more than three years, the Board may, at its discretion, require additional education, supervised clinical practice, or successful passage of examinations (Rule 1150-02-.12(14)(b)2); no rule identifies such an examination.
Continued Competence
Proof of completion of continued competence requirements for the two-year period preceding the reinstatement year (Rule 1150-02-.09(2)(a)3 and .12(14)).
Fees
Payment of the current renewal fee, state mandated fees and the late renewal fee (Rule 1150-02-.09(2)(a)).
Status
The applicant held a Tennessee license that has expired.

Official no-examination sources

Effective from 2026-06-21.

Occupational Therapist Limited Permit

Non-renewable limited permit allowing an occupational therapist applicant who is scheduled for the NBCOT examination to practice under supervision of a licensed occupational therapist.

Licensing authority: Tennessee Board of Occupational Therapy

Limited permit pending examination
OTR exam
Eligibility
Applicant for licensure who has paid the Limited Permit Fee, completed the educational and field experience requirements of Rule 1150-02-.04(1) or (2) (and, for entry-level OTD students, the Experiential Component), and is scheduled to take the examination required by Rule 1150-02-.08 (Rule 1150-02-.14).
Examination Window
The examination must be taken within ninety days of receiving the permit; the permit expires if it is not taken, ceases on failure, and remains effective after a pass until the Board grants or denies a license (Rule 1150-02-.14(1)-(3)).
Limit
Only one limited permit may be obtained; it is non-renewable (Rule 1150-02-.14(4)).
Prior Failure
Individuals who have previously failed the exam once in any state are not eligible for a limited permit in Tennessee (Rule 1150-02-.14).
Supervision
The permit holder may practice only under supervision of a licensed occupational therapist as provided in Rule 1150-02-.10; the Limited Permit Request form must be signed by the supervisor and notarized (Application Instructions item 6).

Occupational Therapy Assistant License

Tennessee license to practice as an occupational therapy assistant under the supervision of a licensed occupational therapist, issued by examination or by reciprocity.

Licensing authority: Tennessee Board of Occupational Therapy

Licensure by examination
COTA Certification Exam
Education
Successful completion of the academic requirements of an ACOTE-accredited (or predecessor) educational program for occupational therapy assistants; graduate transcript sent directly from the degree-granting institution (Rule 1150-02-.04 and .05(1)(f)).
Examination Older Than Three Years
If the application is more than three years after successful completion of the NBCOT examination and the applicant is not applying by reciprocity, the Board may impose additional requirements such as self-assessment, formal learning hours, continuing education in ethics, Tennessee jurisprudence and documentation, and twelve months of supervised practice (Rule 1150-02-.04(3)).
Examination Timing
An application is abandoned if the applicant fails to sit for the written exam within 12 months after being notified of eligibility (Rule 1150-02-.07(8)(a)2).
Fieldwork
Successful completion of the supervised fieldwork experience required by ACOTE (Rule 1150-02-.04).
Good Moral Character
Be of good moral character; submit an original letter of recommendation attesting to good moral character that is not from a relative (Rule 1150-02-.04 and .05(1)(g)).
Internationally Trained
Applicants educated outside the United States must also furnish proof of compliance with T.C.A. § 63-13-214, which requires them to satisfy the examination requirements of § 63-13-202(b) and to show education and fieldwork substantially equal to those required (Rule 1150-02-.04(5)).
Other Documents
Application and fees, passport-style photograph, criminal background check, disclosure of convictions, discipline and civil judgments, Declaration of Citizenship, and English translations where needed (Rule 1150-02-.05(1); Application Instructions PH-3123).
Statutory Alternative Eligibility
Rule 1150-02-.04 also accepts an applicant who is eligible for licensure as provided in T.C.A. § 63-13-213; the Board decides that eligibility.
Reactivation of retired or inactive license
No examination is required for this applicant pathway.
Board Discretion
If the license has been expired or retired for more than three years, the Board may, at its discretion, require additional education, supervised clinical practice, or successful passage of examinations (Rule 1150-02-.12(14)(b)2); no rule identifies such an examination.
Continued Competence
Completion of continued competence requirements for the two-year period preceding the reactivation year (Rule 1150-02-.11(3)(c) and .12(14)).
Fees
Licensure renewal fees and state regulatory fee; late renewal fee and past due renewal fees if reactivation is requested within one year of retirement (Rule 1150-02-.11(3)(b)).
Request
Written request for licensure reactivation to the Board administrative office (Rule 1150-02-.11(3)(a)).
Status
The applicant holds a Tennessee license in retired or inactive status (Rule 1150-02-.11(1)).

Official no-examination sources

Effective from 2026-06-21.

Licensure by reciprocity
COTA Certification Exam
Current Licensure Elsewhere
Proof of current licensure or certification as an occupational therapy assistant in another state, the District of Columbia or a U.S. territory, with verification of licensure status sent directly from every state in which the applicant is or has been licensed (Rule 1150-02-.05(2)(a) and (h)).
Examination Verification
The applicant must have NBCOT send certification examination results directly to the Board (Rule 1150-02-.05(2)(i)). The Board application instructions state: "Reciprocity applicants must have NBCOT submit verification of certification or licensure."
Other Documents
Application and fees, passport-style photograph, criminal background check, disclosure of convictions, discipline and civil judgments, and English translations where needed (Rule 1150-02-.05(2)).
Qualifications
Educational and experiential qualifications that meet or exceed Tennessee requirements, as determined by the Board (Rule 1150-02-.05(2)(a)); graduate transcript from an AOTA-accredited degree-granting institution (Rule 1150-02-.05(2)(g)).
Statutory Waiver
T.C.A. § 63-13-213(2) (text enacted by Public Chapter 415 of 1999) permits the Board to waive the examination, education or experience requirements for an applicant currently licensed or certified in another jurisdiction whose qualifications exceed those required in Tennessee; the Board rule for reciprocity applicants requires NBCOT examination verification.
Reinstatement of expired license
No examination is required for this applicant pathway.
Board Discretion
If the license has been expired or retired for more than three years, the Board may, at its discretion, require additional education, supervised clinical practice, or successful passage of examinations (Rule 1150-02-.12(14)(b)2); no rule identifies such an examination.
Continued Competence
Proof of completion of continued competence requirements for the two-year period preceding the reinstatement year (Rule 1150-02-.09(2)(a)3 and .12(14)).
Fees
Payment of the current renewal fee, state mandated fees and the late renewal fee (Rule 1150-02-.09(2)(a)).
Status
The applicant held a Tennessee license that has expired.

Official no-examination sources

Effective from 2026-06-21.

Occupational Therapy Assistant Limited Permit

Non-renewable limited permit allowing an occupational therapy assistant applicant who is scheduled for the NBCOT examination to practice under supervision of a licensed occupational therapist.

Licensing authority: Tennessee Board of Occupational Therapy

Limited permit pending examination
COTA Certification Exam
Eligibility
Applicant for licensure who has paid the Limited Permit Fee, completed the educational and field experience requirements of Rule 1150-02-.04(1) or (2) (and, for entry-level OTD students, the Experiential Component), and is scheduled to take the examination required by Rule 1150-02-.08 (Rule 1150-02-.14).
Examination Window
The examination must be taken within ninety days of receiving the permit; the permit expires if it is not taken, ceases on failure, and remains effective after a pass until the Board grants or denies a license (Rule 1150-02-.14(1)-(3)).
Limit
Only one limited permit may be obtained; it is non-renewable (Rule 1150-02-.14(4)).
Prior Failure
Individuals who have previously failed the exam once in any state are not eligible for a limited permit in Tennessee (Rule 1150-02-.14).
Supervision
The permit holder may practice only under supervision of a licensed occupational therapist as provided in Rule 1150-02-.10; the Limited Permit Request form must be signed by the supervisor and notarized (Application Instructions item 6).

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