How To Work in The USA : Information for Foreign Trained Occupational Therapists

The American Occupational Therapy Association (AOTA) is the national professional association for occupational therapy practitioners in the United States. Many benefits are available to internationally-trained therapists who join AOTA.

AOTA members have access to information about employment opportunities, practice information, and state licensure requirements. Members can access private listservs regarding a wide variety of practice areas and settings.

Members receive discounts for continuing education products, books, and conferences. Members receive the American Journal of Occupational Therapy (AJOT), AOTA’s professional journal, and OT Practice, a news magazine with practice-related articles that is published 22 times a year.

We recommend becoming a member of AOTA to develop awareness of national policies, professional conduct, and guidelines and standards governing practice in the United States.

Requirements to work in the United States include:

  • Attaining a visa certification.
  • Qualifying to take the certification exam given by the National Board for Certification in Occupational Therapy (NBCOT) and passing it.
  • Passing tests of English language competency, if applicable. For example : TOEFL and TSE.
  • Meeting state regulatory requirements, including attaining a license in those states where it is required.

1. Visas

The U.S. Department of Homeland Security issues visas to foreign nationals wishing to work in the United States. In most cases, this will be a category H1B temporary work visa. See the USCIS website for further details on immigration classification, visa categories, and visa application.

You must get a visa certificate before applying for a visa. Two organizations are authorized by the U.S. Department of Homeland Security to provide visa certification. They are:

National Board for Certification in Occupational Therapy (NBCOT)
Commission on Graduates of Foreign Nursing Schools (CGFNS)

2. Certification Exam

NBCOT is the organization that gives the certification exam, and one must be approved by NBCOT to take the exam. NBCOT and AOTA are completely separate organizations.

NBCOT’s requirement is graduation from an entry-level occupational therapist training program that is accredited by AOTA’s Accreditation Council for Occupational Therapy Education (ACOTE) or approved by the World Federation of Occupational Therapists (WFOT). See the NBCOT Web site for information on exam eligibility and administration.

ACOTE accredits postbaccalaureate programs, and NBCOT requires internationally-trained occupational therapists to meet the same standard. To meet this standard, graduates who do not have post-baccalaureate degrees must submit evidence of equivalent education.

Therapists may not function as occupational therapy assistants (OTAs), as OTAs must graduate from accredited OTA programs and pass the NBCOT exam for OTAs in order to practice. The roles of the OTA and therapist are differentiated and complimentary and not interchangeable.

3. English Language Tests

English is the language spoken in the United States. All candidates must demonstrate English-language proficiency. Graduates of occupational therapy programs in Australia, Canada (except Quebec), Ireland, New Zealand, and the United Kingdom are currently exempt. See NBCOT’s Web site for information.

4. State Regulatory Requirements

Employers require occupational therapy practitioners to meet state regulatory requirements. The first step in this process is becoming certified by NBCOT by meeting its requirements and passing necessary exams.

Therapists must also meet the regulatory requirements of a state of jurisdiction in order to practice. In addition to passing the certification examination, 50 states, the District of Columbia, Guam, and Puerto Rico regulate occupational therapy services. Most of these jurisdictions require continuing education to maintain a license. AOTA provides numerous continuing education opportunities, including online courses, self-paced clinical courses, continuing education articles published in OT Practice, and a yearly Conference along with links to more than 100 additional approved providers across the United States.

Each state in the United States has a regulatory board and a professional association that provides resources regarding practice and continuing education. Contact the state regulatory board to determine the particular requirements of that state for initial and continuing ability to practice occupational therapy.

Information on state associations is located on the AOTA home page.

Some states require a social security number to obtain a state license. Read about getting a social security number.

Employment Resources

Employment is available in many different areas of occupational therapy practice. Job advertisements and career information are published online by AOTA at

Employment advertisements are also published in AOTA’s practice magazine, OT Practice.

You should make inquiries about employment to the specific employer in the job advertisement. Salaries, benefits, and specifics of employment (e.g., experience required, days and hours of employment, travel required, etc.) vary and are determined by the employer. AOTA does not make placement arrangements.

Source : AOTA

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