OpenExamsFREE PRACTICE — ANY EXAM

Virginia Occupational Therapy — Requirements & Free Practice

US-VA · License preparation

605 free questions · Answer explanations · No signup required

Choose what to practice

Start with an exam below. Your examination requirements depend on your application pathway. View licensing requirements

Choose an exam or combined practice to begin.

Licenses, application pathways and examination requirements

Each license and applicant pathway has its own requirements and exemptions. Choosing practice questions does not determine your eligibility.

Occupational Therapist License

Virginia license to practice as an occupational therapist, issued by the Board of Medicine under Code of Virginia § 54.1-2956.1 and 18VAC85-80.

Licensing authority: Virginia Board of Medicine · Application information

Licensure by endorsement
OTR exam
Application
Completed application and fee (18VAC85-80-36 (2)); endorsement fee $130 for an occupational therapist and $70 for an occupational therapy assistant (Board instructions).
Employment Chronology
Employment chronology covering the five years preceding application or since graduation (Board instructions item 2).
Fallback
If the Board deems any endorsement criterion unmet, the application is routed to the traditional pathway for an initial license (Board instructions, guidance item 9).
License Elsewhere
Evidence of a current, active license in a United States jurisdiction or Canada that is in good standing (18VAC85-80-36 (1)); the Board's endorsement instructions (Rev. 11/2025) define good standing as current and unrestricted, or if lapsed, eligible for renewal or reinstatement.
No Grounds For Denial
No grounds for denial under Code of Virginia § 54.1-2915 or Board regulations (Board instructions, eligibility criterion 4).
Npdb
A current report from the National Practitioner Data Bank (18VAC85-80-36 (4)).
Professional Credential
Verification of a professional credential in occupational therapy as required in 18VAC85-80-40 (18VAC85-80-36 (3)); the Board's instructions require a verification letter sent directly from NBCOT and state the eligibility criterion 'Verify passage of the certification examination as an OTR® or COTA® by the National Board for Certification in Occupational Therapy (NBCOT)'.
Initial licensure by examination
OTR exam
Alternative Education
An applicant who does not meet 18VAC85-80-40 A or B but holds NBCOT certification is eligible and provides verification of education, training and work experience acceptable to the Board (18VAC85-80-40 C).
Application
Completed application and fee as prescribed in 18VAC85-80-26 (18VAC85-80-35 (1)).
Education Outside United States
Education received outside the United States: completion of all academic and clinical fieldwork requirements of a program approved by a member association of the World Federation of Occupational Therapists, as verified by the program director and as required by NBCOT, plus proof of English proficiency by passing the TOEFL with a score acceptable to the Board; TOEFL may be waived upon evidence of English proficiency (18VAC85-80-40 B). The Board's application instructions (REV. 01/25) also accept the TSE.
Education United States
Education received in the United States, its possessions or territories: successful completion of all academic and fieldwork requirements of an ACOTE-accredited educational program (18VAC85-80-40 A).
Graduate Practice
A graduate of an accredited program may practice as a License Applicant until receiving a failing score on the NBCOT examination or for six months from graduation, whichever occurs sooner (Code of Virginia § 54.1-2956.5; 18VAC85-80-45).
Other Jurisdictions
If licensed or certified in any other jurisdiction, verification that no disciplinary action has been taken or is pending there (18VAC85-80-35 (4)); NPDB self-query when previously licensed (application instructions item 3).
Other Nbcot Examinations
18VAC85-80-50 also requires passage of 'any other examination required for initial certification from the NBCOT'; no other examination is identified by the Board's sources.
Reactivation of an inactive license (inactive six years or more)
OTR exam
Application
Application as required by the Board and payment of the difference between the inactive and active renewal fees (18VAC85-80-72 B).
Board Discretion
The Board may deny reactivation to a licensee determined to have violated Code of Virginia § 54.1-2915 or 18VAC85-80 (18VAC85-80-72 E).
Form Version
The Board's reactivation form (Revised 08/2025) states: 'shall provide evidence of current certification by the NBCOT or recertification by passage of an examination by the NBCOT.' and requires continued competency hours including 1 hour on human trafficking; 18VAC85-80-72 as amended effective January 29, 2026 governs.
Inactive Period
License inactive for six years or more (18VAC85-80-72 D).
Two Of Four
Provide two of: (1) evidence of a current, active, and unrestricted license in another United States jurisdiction; (2) documentation of completed continued competency hours equal to the requirement for six years; (3) evidence of current NBCOT certification; (4) a passing score on the national examination (NBCOT OTR certification examination) obtained within two years preceding application for reactivation (18VAC85-80-72 D). An applicant who satisfies two of items 1-3 need not sit the examination.
Reactivation of an inactive license (inactive less than six years)
No examination is required for this applicant pathway.
Application
Application as required by the Board and payment of the difference between the inactive and active renewal fees (18VAC85-80-72 B).
Board Discretion
The Board may deny reactivation to a licensee determined to have violated Code of Virginia § 54.1-2915 or 18VAC85-80 (18VAC85-80-72 E).
Continued Competency
Documentation of completed continued competency hours equal to the requirement for the number of years the license has been inactive (18VAC85-80-72 C).
Inactive Period
License inactive for less than six years (18VAC85-80-72 C).

Official no-examination sources

Effective from 2026-01-29.

Reinstatement after revocation
OTR exam
Application
New application and the reinstatement fee of $2,000 (18VAC85-80-80 D; 18VAC85-80-26 A 6).
Burden Of Proof
The applicant must show by clear and convincing evidence that he is safe and competent to practice; reinstatement requires the affirmative vote of three-fourths of the members at the hearing (§ 54.1-2408.2).
Examination Discretion
The application is considered in the same manner as an original license, which requires the national examination under 18VAC85-80-50; 'In the discretion of the board, such reinstatement may be granted without further examination.' (§ 54.1-2408.2).
Waiting Period
The Board may consider the application after three years from revocation, or five years if revoked under Code of Virginia § 54.1-2915 A 19 (§ 54.1-2408.2).
Reinstatement of a license lapsed four years or more
OTR exam
Application
Reinstatement application, information on any practice and licensure or certification in other jurisdictions during the lapse, and the reinstatement fee (18VAC85-80-80 A; 18VAC85-80-26 A 2); NPDB self-query (Board page).
Lapse Period
License lapsed for four years or more (18VAC85-80-80 C).
Two Of Four
Provide two of: (1) evidence of a current, active, and unrestricted license in another United States jurisdiction; (2) documentation of completed continued competency hours equal to the requirement for the number of years lapsed, not to exceed six years; (3) evidence of current NBCOT certification; (4) a passing score on the national examination (NBCOT OTR certification examination) obtained within two years preceding application for reinstatement (18VAC85-80-80 C). An applicant who satisfies two of items 1-3 need not sit the examination.
Reinstatement of a license lapsed two years but less than four years
OTR exam
Application
Reinstatement application, information on any practice and licensure or certification in other jurisdictions during the lapse, and the reinstatement fee (18VAC85-80-80 A; 18VAC85-80-26 A 2); NPDB self-query (Board page).
Lapse Period
License lapsed for two years but less than four years (18VAC85-80-80 B).
One Of Four
Provide one of: (1) evidence of a current, active, and unrestricted license in another United States jurisdiction; (2) documentation of completed continued competency hours equal to the requirement for the number of years lapsed; (3) evidence of current NBCOT certification; (4) a passing score on the national examination (NBCOT OTR certification examination) obtained within the two years preceding application for reinstatement (18VAC85-80-80 B). An applicant who satisfies any of items 1-3 need not sit the examination.
Biennial renewal of licensure
No examination is required for this applicant pathway.
Continued Competency
Attest to at least 10 contact hours of continuing learning activities per biennium from approved organizations; exempt for the first renewal after initial licensure (18VAC85-80-71).
Fee
Renewal fee prescribed in 18VAC85-80-26; late fee if not renewed by the first day of the month following the renewal month (18VAC85-80-70 B).
Timing
Renew biennially during the birth month in each even-numbered year (18VAC85-80-70 A).

Official no-examination sources

Effective from 2025-06-06.

Occupational Therapy Assistant License

Virginia license to practice as an occupational therapy assistant, issued by the Board of Medicine under Code of Virginia § 54.1-2956.1 and 18VAC85-80.

Licensing authority: Virginia Board of Medicine · Application information

Licensure by endorsement
COTA Certification Exam
Application
Completed application and fee (18VAC85-80-36 (2)); endorsement fee $130 for an occupational therapist and $70 for an occupational therapy assistant (Board instructions).
Employment Chronology
Employment chronology covering the five years preceding application or since graduation (Board instructions item 2).
Fallback
If the Board deems any endorsement criterion unmet, the application is routed to the traditional pathway for an initial license (Board instructions, guidance item 9).
License Elsewhere
Evidence of a current, active license in a United States jurisdiction or Canada that is in good standing (18VAC85-80-36 (1)); the Board's endorsement instructions (Rev. 11/2025) define good standing as current and unrestricted, or if lapsed, eligible for renewal or reinstatement.
No Grounds For Denial
No grounds for denial under Code of Virginia § 54.1-2915 or Board regulations (Board instructions, eligibility criterion 4).
Npdb
A current report from the National Practitioner Data Bank (18VAC85-80-36 (4)).
Professional Credential
Verification of a professional credential in occupational therapy as required in 18VAC85-80-40 (18VAC85-80-36 (3)); the Board's instructions require a verification letter sent directly from NBCOT and state the eligibility criterion 'Verify passage of the certification examination as an OTR® or COTA® by the National Board for Certification in Occupational Therapy (NBCOT)'.
Initial licensure by examination
COTA Certification Exam
Alternative Education
An applicant who does not meet 18VAC85-80-40 A or B but holds NBCOT certification is eligible and provides verification of education, training and work experience acceptable to the Board (18VAC85-80-40 C).
Application
Completed application and fee as prescribed in 18VAC85-80-26 (18VAC85-80-35 (1)).
Education Outside United States
Education received outside the United States: completion of all academic and clinical fieldwork requirements of a program approved by a member association of the World Federation of Occupational Therapists, as verified by the program director and as required by NBCOT, plus proof of English proficiency by passing the TOEFL with a score acceptable to the Board; TOEFL may be waived upon evidence of English proficiency (18VAC85-80-40 B). The Board's application instructions (REV. 01/25) also accept the TSE.
Education United States
Education received in the United States, its possessions or territories: successful completion of all academic and fieldwork requirements of an ACOTE-accredited educational program (18VAC85-80-40 A).
Graduate Practice
A graduate of an accredited program may practice as a License Applicant until receiving a failing score on the NBCOT examination or for six months from graduation, whichever occurs sooner (Code of Virginia § 54.1-2956.5; 18VAC85-80-45).
Other Jurisdictions
If licensed or certified in any other jurisdiction, verification that no disciplinary action has been taken or is pending there (18VAC85-80-35 (4)); NPDB self-query when previously licensed (application instructions item 3).
Other Nbcot Examinations
18VAC85-80-50 also requires passage of 'any other examination required for initial certification from the NBCOT'; no other examination is identified by the Board's sources.
Reactivation of an inactive license (inactive six years or more)
COTA Certification Exam
Application
Application as required by the Board and payment of the difference between the inactive and active renewal fees (18VAC85-80-72 B).
Board Discretion
The Board may deny reactivation to a licensee determined to have violated Code of Virginia § 54.1-2915 or 18VAC85-80 (18VAC85-80-72 E).
Form Version
The Board's reactivation form (Revised 08/2025) states: 'shall provide evidence of current certification by the NBCOT or recertification by passage of an examination by the NBCOT.' and requires continued competency hours including 1 hour on human trafficking; 18VAC85-80-72 as amended effective January 29, 2026 governs.
Inactive Period
License inactive for six years or more (18VAC85-80-72 D).
Two Of Four
Provide two of: (1) evidence of a current, active, and unrestricted license in another United States jurisdiction; (2) documentation of completed continued competency hours equal to the requirement for six years; (3) evidence of current NBCOT certification; (4) a passing score on the national examination (NBCOT COTA certification examination) obtained within two years preceding application for reactivation (18VAC85-80-72 D). An applicant who satisfies two of items 1-3 need not sit the examination.
Reactivation of an inactive license (inactive less than six years)
No examination is required for this applicant pathway.
Application
Application as required by the Board and payment of the difference between the inactive and active renewal fees (18VAC85-80-72 B).
Board Discretion
The Board may deny reactivation to a licensee determined to have violated Code of Virginia § 54.1-2915 or 18VAC85-80 (18VAC85-80-72 E).
Continued Competency
Documentation of completed continued competency hours equal to the requirement for the number of years the license has been inactive (18VAC85-80-72 C).
Inactive Period
License inactive for less than six years (18VAC85-80-72 C).

Official no-examination sources

Effective from 2026-01-29.

Reinstatement after revocation
COTA Certification Exam
Application
New application and the reinstatement fee of $2,000 (18VAC85-80-80 D; 18VAC85-80-26 A 6).
Burden Of Proof
The applicant must show by clear and convincing evidence that he is safe and competent to practice; reinstatement requires the affirmative vote of three-fourths of the members at the hearing (§ 54.1-2408.2).
Examination Discretion
The application is considered in the same manner as an original license, which requires the national examination under 18VAC85-80-50; 'In the discretion of the board, such reinstatement may be granted without further examination.' (§ 54.1-2408.2).
Waiting Period
The Board may consider the application after three years from revocation, or five years if revoked under Code of Virginia § 54.1-2915 A 19 (§ 54.1-2408.2).
Reinstatement of a license lapsed four years or more
COTA Certification Exam
Application
Reinstatement application, information on any practice and licensure or certification in other jurisdictions during the lapse, and the reinstatement fee (18VAC85-80-80 A; 18VAC85-80-26 A 2); NPDB self-query (Board page).
Lapse Period
License lapsed for four years or more (18VAC85-80-80 C).
Two Of Four
Provide two of: (1) evidence of a current, active, and unrestricted license in another United States jurisdiction; (2) documentation of completed continued competency hours equal to the requirement for the number of years lapsed, not to exceed six years; (3) evidence of current NBCOT certification; (4) a passing score on the national examination (NBCOT COTA certification examination) obtained within two years preceding application for reinstatement (18VAC85-80-80 C). An applicant who satisfies two of items 1-3 need not sit the examination.
Reinstatement of a license lapsed two years but less than four years
COTA Certification Exam
Application
Reinstatement application, information on any practice and licensure or certification in other jurisdictions during the lapse, and the reinstatement fee (18VAC85-80-80 A; 18VAC85-80-26 A 2); NPDB self-query (Board page).
Lapse Period
License lapsed for two years but less than four years (18VAC85-80-80 B).
One Of Four
Provide one of: (1) evidence of a current, active, and unrestricted license in another United States jurisdiction; (2) documentation of completed continued competency hours equal to the requirement for the number of years lapsed; (3) evidence of current NBCOT certification; (4) a passing score on the national examination (NBCOT COTA certification examination) obtained within the two years preceding application for reinstatement (18VAC85-80-80 B). An applicant who satisfies any of items 1-3 need not sit the examination.
Biennial renewal of licensure
No examination is required for this applicant pathway.
Continued Competency
Attest to at least 10 contact hours of continuing learning activities per biennium from approved organizations; exempt for the first renewal after initial licensure (18VAC85-80-71).
Fee
Renewal fee prescribed in 18VAC85-80-26; late fee if not renewed by the first day of the month following the renewal month (18VAC85-80-70 B).
Timing
Renew biennially during the birth month in each even-numbered year (18VAC85-80-70 A).

Official no-examination sources

Effective from 2025-06-06.

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