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Washington Occupational Therapy — Requirements & Free Practice

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Occupational Therapist License

Washington license to practice as an occupational therapist under chapter 18.59 RCW and chapter 246-847 WAC, issued by the Department of Health with the Occupational Therapy Practice Board.

Licensing authority: Washington State Department of Health, Occupational Therapy Practice Board · Application information

Licensure by endorsement: licensed in another U.S. jurisdiction for less than two years, or in a jurisdiction not substantially equivalent to Washington
OTR exam
Background Check
DOH FAQ: "beginning July 1, 2026, all new applicants, regardless of route to licensure, will be required to undergo a fingerprint background check through the FBI."
Credential Verification
Verification form completed by every jurisdiction where a credential is or was held, sent directly to the department (DOH 683-026).
Current Licensure
Current licensure as an occupational therapist in another state, the District of Columbia, or a U.S. territory (RCW 18.59.070(2); WAC 246-847-125(2)(a)).
Licensure Requirements
Comply with the requirements for licensure in chapter 18.59 RCW and chapter 246-847 WAC (WAC 246-847-125(2)(c)), including education and fieldwork.
Licensure by endorsement: credentialed for at least two years in a substantially equivalent state
No examination is required for this applicant pathway.
Background Check
DOH FAQ: "beginning July 1, 2026, all new applicants, regardless of route to licensure, will be required to undergo a fingerprint background check through the FBI."
Board Application Packet
DOH 683-026 (implementation) also states for this pathway: "Complete the initial applicant requirements listed above;" those items include transcripts and, for an applicant who has taken the NBCOT exam, NBCOT verification of passing. RCW 18.130.077(1) requires the exam requirement to be waived for this route.
Disciplinary Standing
Not subject to denial or conditional license; no disciplinary action for unprofessional conduct or impairment in the two years preceding or during the application; not under investigation or subject to charges during the application (RCW 18.130.077(3)).
Prior Licensure
Credentialed in another state or states with substantially equivalent standards for at least two years immediately preceding the application, with no interruption in licensure longer than 90 days (RCW 18.130.077(1); WAC 246-847-125(1)); the department publishes its list of substantially equivalent states.

Official no-examination sources

Effective from 2025-07-01.

Initial licensure by examination
OTR exam
Background Check
DOH FAQ: "beginning July 1, 2026, all new applicants, regardless of route to licensure, will be required to undergo a fingerprint background check through the FBI."
Education
Graduation from a nationally accredited, board-approved occupational therapy educational program recognized under WAC 246-847-040 (RCW 18.59.050(1)(b)); official transcript sent directly by the school.
Expired License In Another State
Initial applicants whose license in another state expired: not practiced three to five years requires 24 hours of continued competency; five or more years additionally requires a board-approved reentry program and either extended course work or retaking and passing the NBCOT examination (WAC 246-847-067).
Fieldwork
Supervised fieldwork of at least six months (24 weeks) full-time equivalent Level II fieldwork (RCW 18.59.050(1)(c)(i); WAC 246-847-140).
Good Moral Character
The applicant shall be of good moral character (RCW 18.59.050(1)(a)); personal data questions and background check apply.
Internationally Educated
Internationally educated applicants not licensed in another state for at least two years apply through this route and submit employment verification affidavits for positions held in the past three years (DOH 683-026).
Never Practiced Graduated Five Or More Years
Graduated five or more years before applying and never practiced: 24 hours of continued competency, a board-approved reentry program, and either extended course work preapproved by the board or retaking and passing the NBCOT examination (WAC 246-847-055(3)).
Never Practiced Graduated Three To Five Years
Graduated more than three but less than five years before applying and never practiced: 24 hours of continued competency for the previous two years, a board-approved reentry program, and any additional board requirements (WAC 246-847-055(2)).
Oral Interview
The applicant may be required to appear before the board for oral interview (WAC 246-847-055(4); WAC 246-847-067(4)).
Unrecognized Educational Program
An applicant who has passed the NBCOT examination is considered to have met the education and experience requirements of RCW 18.59.050; NBCOT sends verification directly (WAC 246-847-120).
Return to active status: license expired five years or less
No examination is required for this applicant pathway.
Additional Board Requirements
Completion of any additional requirements as required by the board (WAC 246-847-068(5)).
Licensed Elsewhere
A practitioner currently licensed and actively practicing in another U.S. jurisdiction may instead meet the endorsement requirements of WAC 246-847-125 (WAC 246-847-068(4)).
Over Three To Five Years
Additionally complete 24 hours of continuing education within the two years immediately preceding the application (WAC 246-847-068(2)).
Three Years Or Less
Meet WAC 246-12-020 through 246-12-051: abbreviated application where required, late renewal penalty, current renewal and reissuance fees, and written declarations (WAC 246-847-068(1); WAC 246-12-040(3)).

Official no-examination sources

Effective from 2026-06-14.

Return to active status: license expired over five years
OTR exam
Additional Board Requirements
Completion of any additional requirements as required by the board (WAC 246-847-068(5)).
Base Requirements
Meet WAC 246-847-068(2): WAC 246-12-020 through 246-12-051 requirements and 24 hours of continuing education within the two preceding years (WAC 246-847-068(3)(a)).
Examination Alternative
The applicant chooses either extended course work preapproved by the board or retaking and passing the NBCOT examination (WAC 246-847-068(3)(c)).
Licensed Elsewhere
A practitioner currently licensed and actively practicing in another U.S. jurisdiction may instead meet the endorsement requirements of WAC 246-847-125 (WAC 246-847-068(4)).
Reentry Program
Completion of a board-approved reentry program (WAC 246-847-068(3)(b)).
Return to active status from inactive status: inactive five years or less
No examination is required for this applicant pathway.
Additional Board Requirements
Completion of any additional requirements as required by the board (WAC 246-847-070(6)).
Licensed Elsewhere
A practitioner currently licensed and actively practicing in another U.S. jurisdiction may instead meet the endorsement requirements of WAC 246-847-125 (WAC 246-847-070(5)).
Over Three To Five Years
Additionally complete 24 hours of continuing education within the two years immediately preceding the application (WAC 246-847-070(3)).
Three Years Or Less
Meet WAC 246-12-110: written notice, current active renewal fee, and written declarations (WAC 246-847-070(2)).

Official no-examination sources

Effective from 2026-06-14.

Return to active status from inactive status: inactive over five years
OTR exam
Additional Board Requirements
Completion of any additional requirements as required by the board (WAC 246-847-070(6)).
Base Requirements
Meet WAC 246-847-070(3): WAC 246-12-110 requirements and 24 hours of continuing education within the two preceding years (WAC 246-847-070(4)(a)).
Examination Alternative
The applicant chooses either extended course work preapproved by the board or retaking and passing the NBCOT examination (WAC 246-847-070(4)(c)).
Reentry Program
Completion of a board-approved reentry program (WAC 246-847-070(4)(b)).
Licensure of an initial applicant holding current NBCOT national certification
OTR exam
Background Check
DOH FAQ: "beginning July 1, 2026, all new applicants, regardless of route to licensure, will be required to undergo a fingerprint background check through the FBI."
Current Certification
Proof of current NBCOT certification (OTR) in good standing (WAC 246-847-127); NBCOT confers the certification on passing its certification examination, and RCW 18.130.077(2) lets the board waive a separate state examination requirement for nationally certified applicants.
Disciplinary Standing
Must meet RCW 18.130.077(3): not subject to denial or conditional license, no disciplinary action in the preceding two years or during the application, not under investigation or charges.

Occupational Therapist Limited Permit

Ninety-day limited permit under RCW 18.59.040(7) and WAC 246-847-115 allowing an occupational therapist applicant who has completed education and fieldwork to practice under supervision until examination results are made public.

Licensing authority: Washington State Department of Health, Occupational Therapy Practice Board · Application information

Limited permit for an applicant who has completed education and fieldwork and is scheduled for the NBCOT examination
OTR exam
Duration
Valid for ninety days and until examination results are made public; one extension may be granted after a failed examination, under direct supervision (RCW 18.59.040(7); WAC 246-847-115(2); WAC 246-847-135(2)(b)).
Education And Fieldwork
Completed the education and experience requirements of chapter 18.59 RCW or requirements the board deems equivalent (RCW 18.59.040(7)); a program director letter may substitute until transcripts are available (DOH FAQ).
Examination Scheduling
Verification of being scheduled to take the NBCOT examination (DOH FAQ).
Sponsor
A sponsoring occupational therapist holding a current Washington license signs the limited permit attestation; the permit holder waiting for the examination works in association with a Washington-licensed occupational therapist with at least one year of experience (WAC 246-847-135(2)(a)).

Occupational Therapy Assistant License

Washington license to practice as an occupational therapy assistant under chapter 18.59 RCW and chapter 246-847 WAC, issued by the Department of Health with the Occupational Therapy Practice Board.

Licensing authority: Washington State Department of Health, Occupational Therapy Practice Board · Application information

Licensure by endorsement: licensed in another U.S. jurisdiction for less than two years, or in a jurisdiction not substantially equivalent to Washington
COTA Certification Exam
Background Check
DOH FAQ: "beginning July 1, 2026, all new applicants, regardless of route to licensure, will be required to undergo a fingerprint background check through the FBI."
Credential Verification
Verification form completed by every jurisdiction where a credential is or was held, sent directly to the department (DOH 683-026).
Current Licensure
Current licensure as an occupational therapy assistant in another state, the District of Columbia, or a U.S. territory (RCW 18.59.070(2); WAC 246-847-125(2)(a)).
Licensure Requirements
Comply with the requirements for licensure in chapter 18.59 RCW and chapter 246-847 WAC (WAC 246-847-125(2)(c)), including education and fieldwork.
Licensure by endorsement: credentialed for at least two years in a substantially equivalent state
No examination is required for this applicant pathway.
Background Check
DOH FAQ: "beginning July 1, 2026, all new applicants, regardless of route to licensure, will be required to undergo a fingerprint background check through the FBI."
Board Application Packet
DOH 683-026 (implementation) also states for this pathway: "Complete the initial applicant requirements listed above;" those items include transcripts and, for an applicant who has taken the NBCOT exam, NBCOT verification of passing. RCW 18.130.077(1) requires the exam requirement to be waived for this route.
Disciplinary Standing
Not subject to denial or conditional license; no disciplinary action for unprofessional conduct or impairment in the two years preceding or during the application; not under investigation or subject to charges during the application (RCW 18.130.077(3)).
Prior Licensure
Credentialed in another state or states with substantially equivalent standards for at least two years immediately preceding the application, with no interruption in licensure longer than 90 days (RCW 18.130.077(1); WAC 246-847-125(1)); the department publishes its list of substantially equivalent states.

Official no-examination sources

Effective from 2025-07-01.

Initial licensure by examination
COTA Certification Exam
Background Check
DOH FAQ: "beginning July 1, 2026, all new applicants, regardless of route to licensure, will be required to undergo a fingerprint background check through the FBI."
Education
Graduation from a nationally accredited, board-approved occupational therapy assistant educational program recognized under WAC 246-847-050 (RCW 18.59.050(1)(b)); official transcript sent directly by the school.
Education Waiver
The board may waive the occupational therapy assistant educational requirement of RCW 18.59.050(1)(b)(ii) for an applicant who has met the experience and other board requirements; upon successful completion of the examination required of the occupational therapist, the individual shall be granted a license (RCW 18.59.050(2)).
Expired License In Another State
Initial applicants whose license in another state expired: not practiced three to five years requires 24 hours of continued competency; five or more years additionally requires a board-approved reentry program and either extended course work or retaking and passing the NBCOT examination (WAC 246-847-067).
Fieldwork
Supervised fieldwork of at least two months (8 weeks) full-time equivalent Level II fieldwork (RCW 18.59.050(1)(c)(ii); WAC 246-847-150).
Good Moral Character
The applicant shall be of good moral character (RCW 18.59.050(1)(a)); personal data questions and background check apply.
Internationally Educated
Internationally educated applicants not licensed in another state for at least two years apply through this route and submit employment verification affidavits for positions held in the past three years (DOH 683-026).
Never Practiced Graduated Five Or More Years
Graduated five or more years before applying and never practiced: 24 hours of continued competency, a board-approved reentry program, and either extended course work preapproved by the board or retaking and passing the NBCOT examination (WAC 246-847-055(3)).
Never Practiced Graduated Three To Five Years
Graduated more than three but less than five years before applying and never practiced: 24 hours of continued competency for the previous two years, a board-approved reentry program, and any additional board requirements (WAC 246-847-055(2)).
Oral Interview
The applicant may be required to appear before the board for oral interview (WAC 246-847-055(4); WAC 246-847-067(4)).
Unrecognized Educational Program
An applicant who has passed the NBCOT examination is considered to have met the education and experience requirements of RCW 18.59.050; NBCOT sends verification directly (WAC 246-847-120).
Return to active status: license expired five years or less
No examination is required for this applicant pathway.
Additional Board Requirements
Completion of any additional requirements as required by the board (WAC 246-847-068(5)).
Licensed Elsewhere
A practitioner currently licensed and actively practicing in another U.S. jurisdiction may instead meet the endorsement requirements of WAC 246-847-125 (WAC 246-847-068(4)).
Over Three To Five Years
Additionally complete 24 hours of continuing education within the two years immediately preceding the application (WAC 246-847-068(2)).
Three Years Or Less
Meet WAC 246-12-020 through 246-12-051: abbreviated application where required, late renewal penalty, current renewal and reissuance fees, and written declarations (WAC 246-847-068(1); WAC 246-12-040(3)).

Official no-examination sources

Effective from 2026-06-14.

Return to active status: license expired over five years
COTA Certification Exam
Additional Board Requirements
Completion of any additional requirements as required by the board (WAC 246-847-068(5)).
Base Requirements
Meet WAC 246-847-068(2): WAC 246-12-020 through 246-12-051 requirements and 24 hours of continuing education within the two preceding years (WAC 246-847-068(3)(a)).
Examination Alternative
The applicant chooses either extended course work preapproved by the board or retaking and passing the NBCOT examination (WAC 246-847-068(3)(c)).
Licensed Elsewhere
A practitioner currently licensed and actively practicing in another U.S. jurisdiction may instead meet the endorsement requirements of WAC 246-847-125 (WAC 246-847-068(4)).
Reentry Program
Completion of a board-approved reentry program (WAC 246-847-068(3)(b)).
Return to active status from inactive status: inactive five years or less
No examination is required for this applicant pathway.
Additional Board Requirements
Completion of any additional requirements as required by the board (WAC 246-847-070(6)).
Licensed Elsewhere
A practitioner currently licensed and actively practicing in another U.S. jurisdiction may instead meet the endorsement requirements of WAC 246-847-125 (WAC 246-847-070(5)).
Over Three To Five Years
Additionally complete 24 hours of continuing education within the two years immediately preceding the application (WAC 246-847-070(3)).
Three Years Or Less
Meet WAC 246-12-110: written notice, current active renewal fee, and written declarations (WAC 246-847-070(2)).

Official no-examination sources

Effective from 2026-06-14.

Return to active status from inactive status: inactive over five years
COTA Certification Exam
Additional Board Requirements
Completion of any additional requirements as required by the board (WAC 246-847-070(6)).
Base Requirements
Meet WAC 246-847-070(3): WAC 246-12-110 requirements and 24 hours of continuing education within the two preceding years (WAC 246-847-070(4)(a)).
Examination Alternative
The applicant chooses either extended course work preapproved by the board or retaking and passing the NBCOT examination (WAC 246-847-070(4)(c)).
Reentry Program
Completion of a board-approved reentry program (WAC 246-847-070(4)(b)).
Licensure of a graduate of a U.S. military occupational therapy assistant course
COTA Certification Exam
Background Check
DOH FAQ: "beginning July 1, 2026, all new applicants, regardless of route to licensure, will be required to undergo a fingerprint background check through the FBI."
Military Course
Graduate of a United States military occupational therapy assistant course substantially equivalent to chapters 18.59 RCW and 246-847 WAC (WAC 246-847-051).
Military Residency
Proof of completion of the military residency program included in the education program, in lieu of the fieldwork required under WAC 246-847-150 (WAC 246-847-051(1)).
Licensure of an initial applicant holding current NBCOT national certification
COTA Certification Exam
Background Check
DOH FAQ: "beginning July 1, 2026, all new applicants, regardless of route to licensure, will be required to undergo a fingerprint background check through the FBI."
Current Certification
Proof of current NBCOT certification (COTA) in good standing (WAC 246-847-127); NBCOT confers the certification on passing its certification examination, and RCW 18.130.077(2) lets the board waive a separate state examination requirement for nationally certified applicants.
Disciplinary Standing
Must meet RCW 18.130.077(3): not subject to denial or conditional license, no disciplinary action in the preceding two years or during the application, not under investigation or charges.

Occupational Therapy Assistant Limited Permit

Ninety-day limited permit under RCW 18.59.040(7) and WAC 246-847-115 allowing an occupational therapy assistant applicant who has completed education and fieldwork to practice under supervision until examination results are made public.

Licensing authority: Washington State Department of Health, Occupational Therapy Practice Board · Application information

Limited permit for an applicant who has completed education and fieldwork and is scheduled for the NBCOT examination
COTA Certification Exam
Duration
Valid for ninety days and until examination results are made public; one extension may be granted after a failed examination, under direct supervision (RCW 18.59.040(7); WAC 246-847-115(2); WAC 246-847-135(2)(b)).
Education And Fieldwork
Completed the education and experience requirements of chapter 18.59 RCW or requirements the board deems equivalent (RCW 18.59.040(7)); a program director letter may substitute until transcripts are available (DOH FAQ).
Examination Scheduling
Verification of being scheduled to take the NBCOT examination (DOH FAQ).
Sponsor
A sponsoring occupational therapist holding a current Washington license signs the limited permit attestation; the permit holder waiting for the examination works in association with a Washington-licensed occupational therapist with at least one year of experience (WAC 246-847-135(2)(a)).

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