Every step to become a licensed occupational therapist: degree options, fieldwork, the NBCOT exam, state licensure, total cost and a realistic timeline.

<p class="">Becoming an occupational therapist (OT) is a big commitment, but the path is clear once you know the steps. In this guide, we walk you through every stage, from choosing the right degree to passing your board exam and getting your state license. We also break down what it costs and how long it takes, so you can plan with confidence.</p>
<h2 class="">Quick Answer: How Do You Become a Licensed Occupational Therapist?</h2>
<p class="">To become a licensed occupational therapist in the United States, you need to:</p>
<ol style="margin-left:20px">
  <li class="">Earn a bachelor's degree and complete required prerequisite courses</li>
  <li class="">Graduate from an accredited master's or doctoral occupational therapy program</li>
  <li class="">Complete supervised fieldwork, including at least 24 weeks of full-time Level II fieldwork</li>
  <li class="">Pass the national certification exam from the National Board for Certification in Occupational Therapy (NBCOT)</li>
  <li class="">Apply for a license in the state where you plan to work</li>
</ol>
<p class=""></p>
<p class="">Most people finish in about 6 to 7 years after starting college. Total costs vary widely, but graduate tuition alone often runs from about $40,000 to more than $100,000.</p>
<h2 class="">Step 1: Earn a Bachelor's Degree and Complete Prerequisites</h2>
<p class="">OT graduate programs require a bachelor's degree, but it does not have to be in a specific major. Popular choices include psychology, biology, kinesiology, health sciences and exercise science.</p>
<p class="">What matters most is completing each program's prerequisite courses. According to BLS, programs often require coursework in biology, psychology and other sciences. Common prerequisites include:</p>
<ul style="margin-left:20px">
  <li class="">Anatomy and physiology</li>
  <li class="">Psychology, including abnormal and developmental psychology</li>
  <li class="">Statistics</li>
  <li class="">Sociology or anthropology</li>
  <li class="">Medical terminology</li>
</ul>
<p></p>
<p class="">Many programs also ask for observation or volunteer hours in an OT setting. Try to shadow OTs in more than one setting, like a hospital and a school. It strengthens your application and helps you see which areas excite you most.</p>
<p class=""><strong class="">Timeline:</strong> About 4 years</p>
<h2 class="">Step 2: Choose and Complete an Accredited OT Program</h2>
<p class="">To sit for the national exam, you must graduate from a program accredited by the Accreditation Council for Occupational Therapy Education (ACOTE). You can choose between two entry-level degrees:</p>
<p class=""></p>
<table class="">
  <tbody class="">
    <tr class="">
      <td data-row="1" class=""><br class="" /></td>
      <td data-row="1" class=""><strong class="">Master's Degree (MOT or MSOT)</strong></td>
      <td data-row="1" class=""><strong class="">Doctoral Degree (OTD)</strong></td>
    </tr>
    <tr class="">
      <td data-row="2" class=""><strong class="">Typical length</strong></td>
      <td data-row="2" class="">2 to 3 years</td>
      <td data-row="2" class="">About 3 years</td>
    </tr>
    <tr class="">
      <td data-row="3" class=""><strong class="">Level II fieldwork</strong></td>
      <td data-row="3" class="">At least 24 weeks</td>
      <td data-row="3" class="">At least 24 weeks</td>
    </tr>
    <tr class="">
      <td data-row="4" class=""><strong class="">Extra requirement</strong></td>
      <td data-row="4" class="">None</td>
      <td data-row="4" class="">14-week doctoral capstone</td>
    </tr>
    <tr class="">
      <td data-row="5" class=""><strong class="">Qualifies you for the NBCOT exam</strong></td>
      <td data-row="5" class="">Yes</td>
      <td data-row="5" class="">Yes</td>
    </tr>
    <tr class="">
      <td data-row="6" class=""><strong class="">Best for</strong></td>
      <td data-row="6" class="">Getting into practice faster and for less</td>
      <td data-row="6" class="">Interest in research, teaching, leadership or advanced practice</td>
    </tr>
  </tbody>
</table>
<p class=""></p>
<p class="">Here is the good news: both degrees lead to the same license and the same job. ACOTE accredits both master's and doctoral programs and has said it has no plans to require only the doctorate. BLS still lists a master's degree as the typical entry-level education.</p>
<p class="">When comparing programs, look at:</p>
<ul style="margin-left:20px">
  <li class="">Accreditation status (always confirm it is ACOTE accredited)</li>
  <li class="">First-time NBCOT pass rates</li>
  <li class="">Fieldwork sites and how placements are assigned</li>
  <li class="">Total cost, including fees, books and living expenses</li>
  <li class="">Format options, such as hybrid or weekend programs</li>
</ul>
<p></p>
<p class=""><strong class="">Timeline:</strong> 2 to 3 years</p>
<h2 class="">Step 3: Complete Your Fieldwork</h2>
<p class="">Fieldwork is where classroom learning turns into real-world skill. There are two levels:</p>
<ul style="margin-left:20px">
  <li class=""><strong class="">Level I fieldwork</strong> is built into your coursework. It gives you early exposure to practice through observation and guided experiences.</li>
  <li class=""><strong class="">Level II fieldwork</strong> is full-time, supervised clinical work. ACOTE standards require at least 24 weeks. Most students complete it in two or more different settings, such as a hospital and a pediatric clinic.</li>
</ul>
<p></p>
<p class="">If you are in an OTD program, you will also complete a 14-week doctoral capstone after your Level II fieldwork. This is a deeper project in an area like clinical practice, research, program development or advocacy.</p>
<p class="">Plan ahead for fieldwork. Some placements are far from campus, and you may need to cover travel and short-term housing.</p>
<h2 class="">Step 4: Pass the NBCOT Exam</h2>
<p class="">After graduation, you will take the National Board for Certification in Occupational Therapy exam. Passing it earns you the Occupational Therapist, Registered (OTR) credential, and it is required for licensure in every state.</p>
<p class="">Here is what to know about the OTR exam:</p>
<ul style="margin-left:20px">
  <li class=""><strong class="">Fee:</strong> $540 for the online application</li>
  <li class=""><strong class="">Format:</strong> 180 questions in 4 hours</li>
  <li class=""><strong class="">Location:</strong> In person at Pearson VUE test centers</li>
  <li class=""><strong class="">Passing score:</strong> A scaled score of 450 or higher</li>
  <li class=""><strong class="">Scheduling:</strong> Once approved, you get an Authorization to Test (ATT) letter and must test within the window it gives you, typically 90 days</li>
</ul>
<p class=""></p>
<p class="">Most new grads study for 1 to 3 months. Use practice exams, study groups and your program's review resources. Build a study plan early, ideally during your final fieldwork rotation.</p>
<p class=""><strong class="">Timeline:</strong> About 1 to 3 months after graduation</p>
<h2 class="">Step 5: Apply for Your State License</h2>
<p class="">Every state requires OTs to be licensed. NBCOT certifies you nationally, but your state board gives you the legal right to practice. Requirements vary, but most states ask for:</p>
<ul style="margin-left:20px">
  <li class="">A completed application and fee</li>
  <li class="">Your NBCOT score transfer</li>
  <li class="">Official transcripts</li>
  <li class="">A background check</li>
  <li class="">In some states, a jurisprudence exam on state laws and rules</li>
</ul>
<p></p>
<p class="">Processing usually takes a few weeks. Some states offer temporary permits so new grads can begin working under supervision while they wait for exam results. Check with your state board for details.</p>
<h3 class="">What About the OT Licensure Compact?</h3>
<p class="">The Occupational Therapy Licensure Compact is a game changer for OTs who want to work in more than one state. Instead of applying for a full license in each state, eligible OTs can apply for a "compact privilege," which works like a license in other member states.</p>
<p class="">As of October 2026, 37 states have joined the compact. According to the American Occupational Therapy Association (AOTA), 10 states are actively issuing compact privileges: Arkansas, Indiana, Maryland, Minnesota, Mississippi, Ohio, Tennessee, Virginia, West Virginia and Wisconsin. More states are expected to come online as they connect to CompactConnect, the system used to apply.</p>
<p class=""><strong class="">Timeline:</strong> A few weeks, depending on your state</p>
<h2 class="">How Much Does It Cost to Become an Occupational Therapist?</h2>
<p class="">Costs depend on your school, your state and whether you choose a master's or doctoral program. Here is a general breakdown:</p>
<p class=""></p>
<table class="">
  <tbody class="">
    <tr class="">
      <td data-row="1" class=""><strong class="">Expense</strong></td>
      <td data-row="1" class=""><strong class="">Typical Cost</strong></td>
    </tr>
    <tr class="">
      <td data-row="2" class=""><strong class="">Bachelor's degree</strong></td>
      <td data-row="2" class="">Varies widely by school and residency</td>
    </tr>
    <tr class="">
      <td data-row="3" class=""><strong class="">OT graduate program tuition</strong></td>
      <td data-row="3" class="">About $40,000 to $100,000 or more</td>
    </tr>
    <tr class="">
      <td data-row="4" class=""><strong class="">Fieldwork travel and housing</strong></td>
      <td data-row="4" class="">Varies by placement</td>
    </tr>
    <tr class="">
      <td data-row="5" class=""><strong class="">NBCOT exam (online application)</strong></td>
      <td data-row="5" class="">$540</td>
    </tr>
    <tr class="">
      <td data-row="6" class=""><strong class="">Exam study materials</strong></td>
      <td data-row="6" class="">Varies; free to a few hundred dollars</td>
    </tr>
    <tr class="">
      <td data-row="7" class=""><strong class="">State license application</strong></td>
      <td data-row="7" class="">Varies by state (for example, $150 in Louisiana)</td>
    </tr>
    <tr class="">
      <td data-row="8" class=""><strong class="">Background check and jurisprudence exam</strong></td>
      <td data-row="8" class="">Varies by state</td>
    </tr>
    <tr class="">
      <td data-row="9" class=""><strong class="">NBCOT certification renewal</strong></td>
      <td data-row="9" class="">$65 online</td>
    </tr>
  </tbody>
</table>
<p class=""></p>
<p class="">For a sense of the range, a public program like the University of Southern Maine lists total MOT program costs of about $47,000, while some private programs list more than $95,000 in direct program costs.</p>
<p class="">Ways to lower the cost:</p>
<ul style="margin-left:20px">
  <li class="">Compare in-state public programs</li>
  <li class="">Apply for scholarships through your school and professional groups</li>
  <li class="">Look into graduate assistantships</li>
  <li class="">Research loan repayment and forgiveness programs, including those for working in underserved areas</li>
  <li class="">Consider the earning power of flexible roles, like travel or per diem work, once you are licensed</li>
</ul>
<h2 class="">How Long Does It Take to Become an Occupational Therapist?</h2>
<p class="">Here is a realistic timeline from start to finish:</p>
<p class=""></p>
<table class="">
  <tbody class="">
    <tr class="">
      <td data-row="1" class=""><strong class="">Stage</strong></td>
      <td data-row="1" class=""><strong class="">Time</strong></td>
    </tr>
    <tr class="">
      <td data-row="2" class=""><strong class="">Bachelor's degree and prerequisites</strong></td>
      <td data-row="2" class="">About 4 years</td>
    </tr>
    <tr class="">
      <td data-row="3" class=""><strong class="">OT program (master's or doctorate)</strong></td>
      <td data-row="3" class="">2 to 3 years</td>
    </tr>
    <tr class="">
      <td data-row="4" class=""><strong class="">NBCOT exam prep and testing</strong></td>
      <td data-row="4" class="">1 to 3 months</td>
    </tr>
    <tr class="">
      <td data-row="5" class=""><strong class="">State licensure</strong></td>
      <td data-row="5" class="">A few weeks</td>
    </tr>
    <tr class="">
      <td data-row="6" class=""><strong class="">Total</strong></td>
      <td data-row="6" class="">About 6 to 7.5 years</td>
    </tr>
  </tbody>
</table>
<p class=""></p>
<p class="">Already have a bachelor's degree? You could be licensed in about 2.5 to 3.5 years, depending on your program and whether you need to finish prerequisites.</p>
<h2 class="">Keeping Your License and Credential Active</h2>
<p class="">Once you are licensed, you will need to keep both your state license and your NBCOT credential current:</p>
<ul style="margin-left:20px">
  <li class=""><strong class="">State license:</strong> Renew on your state's schedule, which usually includes continuing education hours.</li>
  <li class=""><strong class="">NBCOT certification:</strong> Your first renewal is due four years after you certify, then every three years. You need 36 professional development units each cycle.</li>
</ul>
<p class=""></p>
<p class="">Continuing education also helps you grow your career.</p>
<h2 class="">Starting Your OT Career as a New Grad</h2>
<p class="">You passed your exam and earned your license. Now what? The first year is a great time to build a strong foundation. Look for roles with good mentorship and a supportive team.</p>
<p class="">Dreaming of travel? Most travel OT roles ask for at least one year of recent experience, but planning early pays off. Read <a href="https://www.crosscountry.com/blog/travel-allied-health-for-new-grads-when-is-the-right-time-to-start" rel="noopener noreferrer" class="">Travel Allied Health for New Grads: When Is the Right Time to Start?</a> to map out your timing.</p>
<h2 class="">Ready for Your Next Step?</h2>
<p class="">Your OT license opens the door to meaningful, flexible work in hospitals, schools, homes and communities. Cross Country is here to help you find the right fit at every stage of your career. <a href="https://www.crosscountry.com/apply-now" rel="noopener noreferrer"  class="">Apply now</a> to connect with a recruiter.</p>
<h2 class="">Frequently Asked Questions</h2>
<h3 class="">Do you need a doctorate to become an occupational therapist?</h3>
<p class="">No. You can become a licensed OT with either a master's degree or a doctorate from an ACOTE-accredited program. Both qualify you for the NBCOT exam and state licensure.</p>
<h3 class="">How hard is the NBCOT exam?</h3>
<p class="">The NBCOT exam is challenging, but most well-prepared candidates pass. It has 180 questions over 4 hours, and you need a scaled score of 450 to pass. A structured study plan of 1 to 3 months is common.</p>
<h3 class="">Can I become an OT if my bachelor's degree is in another field?</h3>
<p class="">Yes. OT programs accept bachelor's degrees in any major as long as you complete the required prerequisite courses and meet other admission requirements.</p>
<h3 class="">Can a COTA become an OT?</h3>
<p class="">Yes. Certified occupational therapy assistants can go back to school, complete an accredited OT program and then take the OTR exam. Some programs offer bridge options for working COTAs.</p>
<h3 class="">Can I work in multiple states as an OT?</h3>
<p class="">Yes. You can hold licenses in more than one state, and the OT Licensure Compact is making it easier. Eligible OTs whose home state is actively issuing privileges can apply to practice in other participating states.</p>
<h2 class="">Sources</h2>
<ul style="margin-left:20px">
  <li class=""><a href="https://www.bls.gov/ooh/healthcare/occupational-therapists.htm" rel="noopener noreferrer" target="_blank" class="">U.S. Bureau of Labor Statistics, Occupational Outlook Handbook: Occupational Therapists</a></li>
  <li class=""><a href="https://www.nbcot.org/fees" rel="noopener noreferrer" target="_blank" class="">NBCOT Fees</a></li>
  <li class=""><a href="https://acoteonline.org/accreditation-explained/standards/" rel="noopener noreferrer" target="_blank" class="">ACOTE Accreditation Standards</a></li>
  <li class=""><a href="https://www.aota.org/advocacy/advocacy-news/2026/ot-licensure-compact-begins-issuing-privileges" rel="noopener noreferrer" target="_blank" class="">AOTA: OT Licensure Compact Begins Issuing Privileges</a></li>
  <li class=""><a href="https://usm.maine.edu/student-financial-services/graduate-tuition-fees/occupational-therapy/" rel="noopener noreferrer" target="_blank" class="">University of Southern Maine, Occupational Therapy Tuition and Fees</a></li>
</ul>



How to Become an Occupational Therapist: Cost & Timeline

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How to Become a Licensed Occupational Therapist: Steps, Cost and Timeline

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