How to Get a US OT License as a Foreign-Trained Occupational Therapist

This guide is for internationally educated occupational therapists (IEOTs) seeking Registered Occupational Therapist (OTR) certification and state licensure in the United States. Whether you trained in Canada, the United Kingdom, Australia, India, or another country, the pathway to US OT licensure centers on NBCOT credential review, meeting education equivalency requirements, passing the NBCOT OTR exam, and obtaining state licensure.

Demand for licensed occupational therapists remains strong across all 51 states we track. This guide walks through the most common pathway used by foreign-trained OTs, from initial document gathering through receiving your state license.

Step 1: Credential Evaluation

NBCOT (National Board for Certification in Occupational Therapy) evaluates the academic credentials of internationally educated OT applicants as part of the exam eligibility determination process. Some applicants also use general credential evaluation services such as WES or ECE for the non-OT portion of their transcripts, depending on NBCOT's current requirements.

Documents you will typically need:

• Official OT program transcripts (sent directly from your institution)
• Degree or diploma certificate
• Documentation of supervised fieldwork hours completed during your program
• License or registration verification from your home country's OT regulatory authority (if applicable)
• Copy of your passport (identity verification)

Processing time for credential review varies depending on NBCOT's current workload and how quickly your institutions respond to verification requests. Start this step as early as possible, as obtaining documents from international institutions is often the longest part of the process.

Step 2: Meet US Education Equivalency

After NBCOT reviews your credentials, they will determine whether your OT education is equivalent to a US entry-level OT degree. US OT programs at the entry level are at the master's or doctoral level (Master of Occupational Therapy or Doctorate of Occupational Therapy).

If your education does not fully meet US equivalency standards, NBCOT may require you to:

• Complete additional didactic coursework in specific content areas
• Accumulate additional supervised fieldwork hours (Level II fieldwork) in a US or approved clinical setting

Once any required coursework or fieldwork is completed, you submit the documentation to NBCOT for final review before receiving authorization to sit for the exam.

Step 3: NBCOT OTR Certification Exam

The NBCOT OTR exam is the national certification examination for occupational therapists in the United States. Passing the exam earns you the OTR (Occupational Therapist Registered) credential. You must pass the NBCOT exam regardless of your country of origin or years of OT experience abroad.

• Registration: Through NBCOT after your credentials are approved and your application is accepted
• Testing centers: Administered at Prometric testing centers, with some international locations available
• Exam format: Computer-based with multiple-choice questions and clinical simulation items

LicenseMap covers OT licensing requirements across all 51 states, including exam details, fees, and continuing education requirements.

Step 4: State Licensure

Once you have passed the NBCOT OTR exam and completed your credential review, you can apply for licensure with the occupational therapy licensing board in the state where you intend to practice. Each state has its own application process, fees, and additional requirements.

LicenseMap tracks OT licensing requirements across 51 states. Visit our state-by-state OT requirements page to find specific application details, fees, and continuing education requirements for any state.

Credential Evaluation Organizations

NBCOT is the primary organization that evaluates international OT credentials for exam eligibility. Start your application directly through NBCOT.

World Education Services (WES) may be used for evaluating the general academic education components of your transcripts, depending on NBCOT's current requirements. Check with NBCOT to confirm whether a WES evaluation is required or accepted for your application.

Visa & Immigration Overview

International occupational therapists pursuing US employment typically use one of the following visa categories:

• H-1B (Specialty Occupation) — Occupational therapy is generally considered a specialty occupation eligible for H-1B classification. Subject to annual caps and requires employer sponsorship.
• EB-3 (Skilled Worker) — An employment-based immigrant visa (green card) category available to OTs sponsored by a US employer. Processing times vary significantly by country of origin.

Estimated Costs

The following table provides approximate costs for the major steps in the international OT licensure pathway. Actual fees may vary.

Costs are approximate and subject to change. Additional expenses may include document translation, courier fees for international transcripts, and immigration attorney fees.

Frequently Asked Questions

Related Resources

• OT License Requirements by State — Compare requirements, fees, and compact status across all 51 states
• International Credential Evaluation Guide — Overview of credential evaluation for all professions