Becoming an occupational therapist in the United States means earning a master’s degree or higher from an accredited program, completing supervised fieldwork, passing the national NBCOT exam, and getting licensed in the state where you plan to work. The whole path usually takes six to seven years after high school. Pay varies widely by setting and location, but median annual wages for occupational therapists were about $93,000 in recent federal data.
What Does an Occupational Therapist Actually Do?
Occupational therapy helps people do the daily activities that matter to them after injury, illness, or disability. That could mean relearning to dress yourself after a stroke, adapting a kitchen so someone with arthritis can cook, or helping a child with sensory processing challenges participate in school.
The word “occupation” here doesn’t mean jobs. It means the activities that occupy your day. Dressing, eating, working, driving, playing, sleeping. An OT looks at where a person’s function breaks down and figures out how to restore it, work around it, or adapt the environment so the person can participate.
This is different from physical therapy, though the two overlap. Physical therapy tends to focus on movement, strength, and mobility. Occupational therapy focuses on function and daily participation. A PT might help you walk again. An OT might help you figure out how to carry a cup of coffee while using a walker.
OTs work in hospitals, skilled nursing facilities, schools, outpatient clinics, home health, mental health settings, and community programs. The setting you choose changes your day-to-day work more than almost anything else.
How To Become An Occupational Therapist: Steps Salary Overview
Here is the full path from high school to practicing OT, step by step.
Step 1: Earn a Bachelor’s Degree
You need a bachelor’s degree before entering an OT master’s program. There is no required major, but most applicants complete prerequisites in anatomy, physiology, psychology, statistics, and sometimes kinesiology or sociology. Common undergraduate majors include kinesiology, psychology, biology, and health sciences.
Keep your GPA competitive. OT programs are selective, and most weigh prerequisite GPA heavily.
Step 2: Complete Observation Hours
Most OT programs require documented observation or volunteer hours with a licensed occupational therapist. Requirements vary by program, so check each school’s specific requirement. This step also helps you confirm the field is right for you before committing to graduate school.
Step 3: Earn a Master’s Degree in Occupational Therapy
The entry-level degree for occupational therapists in the US is now a master’s degree. Programs are accredited by the Accreditation Council for Occupational Therapy Education (ACOTE). A master’s typically takes two to two-and-a-half years of full-time study, including classroom work and Level I fieldwork.
Some schools offer a doctoral entry-level degree (OTD). The OTD takes longer and costs more. Both the master’s and the doctoral degree qualify you to sit for the national exam and practice. The profession has discussed moving to a doctoral-only entry requirement, but as of now a master’s degree remains sufficient for licensure.
Step 4: Complete Level II Fieldwork
Level II fieldwork is full-time, supervised clinical training. It is part of the degree program, not a separate step after graduation. Students typically complete two or more Level II placements in different practice settings, each lasting several weeks.
Step 5: Pass the NBCOT Exam
After graduating from an accredited program, you register for the national certification exam administered by the National Board for Certification in Occupational Therapy (NBCOT). Passing this exam earns you the OTR (Occupational Therapist Registered) credential. You can retake the exam if you do not pass on the first attempt, but there are waiting periods and fees.
Step 6: Get Licensed in Your State
Every state regulates occupational therapy licensure. Requirements vary, but all states require passing the NBCOT exam and completing an accredited degree. Some states have additional requirements. You apply to your state’s licensing board after passing the exam.
Step 7: Maintain Certification and Licensure
Both NBCOT certification and state licenses require renewal. Renewal typically involves continuing education units (CEUs). Requirements differ by state and by certification cycle.
How Long Does It Take To Become an Occupational Therapist?
Plan on six to seven years after high school. Four years for the bachelor’s degree, then two to two-and-a-half years for the master’s. Add time if you take a gap year, need to retake prerequisites, or choose a doctoral program.
The timeline is not flexible in one important way. You cannot skip the degree. There is no apprenticeship route, no on-the-job training path, and no shortcut around the accredited graduate program requirement. This is one of the more structured healthcare careers in that respect.
How Much Do Occupational Therapists Earn?
Median annual wages for occupational therapists were about $93,000 according to the most recent data from the US Bureau of Labor Statistics. The middle half of OTs earned roughly between $78,000 and $110,000. The lowest 10 percent earned below $65,000 and the highest 10 percent above $125,000.
These are national figures. Your actual pay depends heavily on where you work and what setting you choose.
| Setting | Typical Pay Pattern |
|---|---|
| Skilled nursing facilities | Often higher than average |
| Home health | Often higher, with per-visit pay models |
| Hospitals | Middle to upper range |
| Schools | Often lower, but school-year schedule |
| Outpatient clinics | Middle range |
Geographic location matters as much as setting. States with higher cost of living and stronger healthcare labor markets generally pay more. Some rural areas pay premiums to attract therapists because of shortages.
Pay also tends to rise with experience, though not as steeply as in some other healthcare fields. Many OTs take on supervisory roles, teaching, or travel contracts to increase income.
What Does the Job Market Look Like for Occupational Therapists?
Demand for occupational therapy services is expected to grow as the US population ages. Older adults are the largest users of OT services, and the number of Americans over 65 keeps rising. That demographic shift supports steady demand.
Other factors that drive demand include improved survival rates after stroke and traumatic injury, growing recognition of OT’s role in mental health, and expanded services in schools for children with disabilities.
The job market is not equally strong everywhere. Some metropolitan areas have more OTs than openings, which can hold down starting pay. Rural and underserved areas often have the opposite problem.
One thing worth understanding: OT is not a field where you can easily work remotely in a traditional sense. Most of the work is hands-on and in person. Some roles in telehealth, consulting, and case management exist, but they are a small share of jobs. If remote work matters to you, this field may not fit.
What Should You Know Before Choosing This Career?
The work is physically demanding. OTs lift, transfer, and reposition patients. Back injuries and repetitive strain are real concerns in the profession. You will spend a lot of time on your feet.
The emotional side is also significant. You work with people who are often frightened, frustrated, or grieving the loss of function. That can be meaningful work. It can also be draining. Burnout is a documented issue in rehabilitation professions.
The educational cost is substantial. Graduate tuition for OT programs varies widely, and many students take on loans. The salary is solid but not high enough to make debt irrelevant. Run the numbers for the specific programs you are considering before you commit.
On the positive side, the work is concrete. You see people improve. You build long relationships with patients and their families. The field has clear scope, strong professional identity, and reasonable job security.
Is Occupational Therapy a Good Career Choice?
It depends on what you want. If you want hands-on work that directly helps people function better in daily life, stable demand, and a clear path to licensure, OT is a strong fit. The path is long and expensive, but it is well-defined and the outcomes are predictable.
If you want high earning potential, remote work, or a fast route to practice, this field will frustrate you. The ceiling on pay is real, and the training is not short.
The most useful thing you can do before committing is to spend time observing an OT in a setting you find interesting. The day-to-day reality of the job is the best predictor of whether it will suit you.
Frequently Asked Questions
How long does it take to become an occupational therapist?
It usually takes six to seven years after high school. That includes four years for a bachelor’s degree and two to two-and-a-half years for a master’s degree in occupational therapy.
What degree do you need to be an occupational therapist?
You need a master’s degree or higher from an ACOTE-accredited occupational therapy program. A doctoral degree (OTD) also qualifies you, but a master’s is currently sufficient for licensure.
How much do occupational therapists make?
Median annual wages were about $93,000 in recent federal data, with the middle half earning roughly $78,000 to $110,000. Pay depends heavily on setting, location, and experience.
Do you need a license to work as an occupational therapist?
Yes. Every US state requires a license to practice occupational therapy. Licensure requires graduating from an accredited program and passing the NBCOT exam.
