How to Become an Occupational Therapist: A Step-by-Step Guide

If you’ve landed here, chances are you’ve seen what occupational therapy can do. Maybe you had a family member relearn how to dress after a stroke, maybe a child in your life started thriving after working with an OT, or maybe you shadowed a therapist and thought, “this is it, this is what I want to do.” I felt that same pull back when I worked as a CNA at a rehab hospital, and I can tell you even after practicing OT for over ten years now that I still think it’s one of the most rewarding careers.

But knowing you want to be an OT and knowing exactly how to get there are two different things. The path is well-defined, but it’s long, and there’s a fair amount of confusing (and sometimes outdated) information floating around online. So I’ll walk you through how to become an occupational therapist from start to finish: the degrees, the timeline, the prerequisites, and everything in between.

The Big Picture: What Does It Take to Become an OT?

At the highest level, becoming an OT comes down to four, sometimes five, steps:

1. Earn a bachelor’s degree (in any major, as long as you complete the prerequisites).
2. Possibly take the GRE (many OT schools are now phasing this out)
3. Complete a graduate-level occupational therapist degree, either a Master’s or a Doctorate (from an ACOTE-accredited program).
4. Pass the national certification exam (the NBCOT).
5. Get licensed in your state.

Every practicing OT in the United States has followed some version of this route. Now let’s break down each piece.

Step 1: Earn Your Bachelor’s Degree

Every path to becoming an occupational therapist starts with a bachelor’s degree. This is non-negotiable, since OT is a graduate-level profession–you can’t enter it straight out of high school (unless you find a specific five year Bachelor’s to Master’s OT program, which are much less common than graduate OT programs). 

What to Major in to Become an Occupational Therapist

Here’s the good news: there’s no single required major. When people ask me what to major in to become an occupational therapist, my honest answer is whatever you’re interested in (while completing the prerequisites). OT programs care far more about your prerequisite coursework and GPA than the name of your degree.

That said, some majors line up naturally with OT prerequisites and make your life easier:

• Kinesiology or exercise science: Heavy on anatomy and physiology, which are core prereqs
• Psychology: overlaps with the mental health foundation of OT
• Biology or health sciences: covers the science-heavy requirements
• Sociology or human development: aligns with OT’s holistic, whole-person approach

I’ve worked alongside OTs who majored in education, business, and even journalism, they simply took their prerequisite courses on the side or after they graduated. So pick a major you’re genuinely interested in, keep your GPA strong, and make sure you knock out those prerequisites along the way.

For more on what undergrad majors work well for occupational therapy, be sure to check out our companion article, 7 Best Undergraduate Majors for Occupational Therapy.

OT Education Requirements: The Prerequisites

Before you can even apply to graduate school, you’ll need to complete a set of prerequisite courses. These OT education requirements vary slightly from program to program, so always check the specific schools you’re targeting, but the most common OT prerequisites include:

• Human anatomy and physiology (often two semesters, with labs)
• Psychology (introductory, plus abnormal and/or developmental psychology)
• Sociology 
• Statistics
• Biology 
• Medical terminology
• Sometimes physics

On top of the coursework, most programs want to see observation hours in occupational therapy settings, often somewhere between 20 and 100 hours, and sometimes across more than one setting (like a hospital and a pediatric clinic). These hours do double duty: they strengthen your application, and they help you confirm this is the right career before you commit years and tuition dollars to it.

Step 2: Choose Your Occupational Therapist Degree

This is where a lot of prospective students get confused, so let’s clear it up. To practice as an OT, the education needed to become an occupational therapist is a graduate degree at one of two levels:

• Master’s degree in occupational therapy (MOT or MSOT)
• Entry-level doctorate in occupational therapy (OTD)

This is what the profession calls a dual point of entry. Both degrees are accredited by the Accreditation Council for Occupational Therapy Education (ACOTE), both make you eligible to sit for the same national exam, and both lead to the exact same license and job title. A patient will never know or care whether their OT holds a master’s or a doctorate.

For an in-depth deep dive on the differences between the two, and which one I typically recommend, see my article The MOT vs. OTD: Which Degree Should You Pursue?

Wait–Isn’t a Doctorate Going to Be Required by 2027?

You may have read that a Doctorate (OTD) will soon be mandatory. This is one of the most persistent pieces of misinformation in our field, so let me set the record straight.

Back in 2017, ACOTE did announce a plan to move OT to a doctorate-only entry point by 2027. But after significant pushback from practitioners, faculty, and students, that mandate was put on hold indefinitely in 2019, and it remains on hold today. ACOTE now states plainly that there is no mandate requiring OT programs to move to the doctoral level. Schools can choose to offer a master’s, a doctorate, or both.

Even if the profession did eventually shift to a single doctoral entry point, current Master’s-level OTs would be grandfathered in and would not need to go back for additional education. So if a master’s is the right fit for your goals and budget, it remains a completely valid, respected path and actually pays about the same as a much more expensive doctorate.

So Which OT Degree Should You Choose?

Since both credentials qualify you for the same clinical roles, the decision usually comes down to your goals, time, and finances:

• Choose a master’s (MOT/MSOT) if you want the most direct, typically more affordable route into clinical practice.
• Choose an entry-level doctorate (OTD) if you’re drawn to leadership, research, academia, program development, or advocacy, and you want the extra training a doctoral capstone provides. I will say that this is more expensive, takes longer and can always be completed later on after you’ve been practicing with your master’s. 

Applying to OT School

Most graduate OT programs accept applications through a centralized system called OTCAS (the Occupational Therapist Centralized Application Service), which lets you apply to multiple schools with one application. A few programs apply outside of OTCAS, so double-check each school’s process.

A competitive application typically includes:

• A strong GPA (both overall and in your prerequisite courses)
• Completed observation hours
• Letters of recommendation
• A personal statement
• GRE scores (though many programs have dropped this requirement, so verify before you register for the test)

OT programs are competitive, so give yourself time to build a well-rounded application rather than scrambling to meet deadlines your senior year.

How Long Is Occupational Therapy School?

Now for the question I get asked often: how long does it take to become an occupational therapist? Let’s break the OT school length down by stage.

• Bachelor’s degree: ~4 years
• Master’s degree (MOT/MSOT): typically 2 to 2.5 years
• Entry-level doctorate (OTD): typically about 3 years (often 33–36 months)
• Entry-level bachelor’s to master’s/doctorate: typically 5-6 years total

So the answer to how long is occupational therapy school depends on which graduate degree you pursue–roughly two to three years of graduate study after your bachelor’s.

Add it all up, and the total timeline from starting your undergraduate degree to becoming a licensed, practicing OT is generally 6 to 7 years. If you already hold a bachelor’s degree, you’re looking at 2 to 3 years of graduate school plus the time to complete your prerequisites and fieldwork.

A quick note on OT school length and formats: because occupational therapy requires extensive hands-on clinical training, there’s no such thing as a fully online OT degree. Some programs offer hybrid coursework, but the fieldwork must always happen in person.

Fieldwork and the Doctoral Capstone

Speaking of hands-on training, fieldwork is one of the most important parts of OT school. Accredited programs require:

• Level I fieldwork: shorter, observational placements woven throughout your coursework, exposing you to different practice settings
• Level II fieldwork: full-time, immersive placements, usually around 24 weeks total, where you gradually take on a real clinical caseload under a licensed OT’s supervision

If you pursue an OTD, you’ll also complete a doctoral capstone experience focused on an area like advanced clinical practice, research, leadership, advocacy, or education. This is one of the key differences between the master’s and doctoral paths.

Step 3: Pass the NBCOT Exam and Get Licensed

Graduating from your ACOTE-accredited program isn’t quite the finish line. After you graduate, you’ll sit for the national certification exam administered by the National Board for Certification in Occupational Therapy (NBCOT). Passing earns you the credential OTR (Occupational Therapist, Registered).

From there, every U.S. state requires you to obtain a license to practice. State licensure is typically based on passing the NBCOT, so once you’ve passed the exam, applying for your license is usually straightforward. Requirements vary a bit by state, so check your specific state’s licensing board.

Once you’re licensed, you’re officially an occupational therapist–congratulations, you made it!

Is It Worth It? OT Job Outlook and Salary

I won’t sugarcoat it: this is a long, demanding path. But the career on the other side is stable, meaningful, and well-compensated.

According to the U.S. Bureau of Labor Statistics, the median annual wage for occupational therapists was $98,340 as of May 2024, with the lowest 10% earning under about $67,090 and the top 10% earning more than roughly $129,830. Pay tends to run higher in home health and skilled nursing settings and somewhat lower in school-based roles (which come with the trade-off of following an academic calendar).

Just as encouraging is the demand. The BLS projects 14% employment growth for OTs from 2024 to 2034, much faster than the average for all occupations, with about 10,200 openings per year over the decade, and OT is currently said to be a very AI-proof profession.

Final Thoughts

So, how do you become an occupational therapist? You earn a bachelor’s degree and knock out your prerequisites, complete an ACOTE-accredited master’s or doctorate, pass the NBCOT exam, and get licensed in your state. Start to finish, plan on roughly six to seven years.

It’s a big commitment, but if you’re the kind of person who lights up at the idea of helping someone rebuild the everyday skills that make life life (getting dressed, cooking a meal, returning to work, playing on the playground), I promise the journey is worth it.

If you’re just getting started, my best advice is to rack up those observation hours early, keep your grades up, and reach out to OTs in your community. We are more than happy to answer questions and cheer on the next generation of therapists. 

This article is intended as general educational guidance. Program requirements, prerequisites, and licensing rules vary by school and state, so always confirm the specifics with your target programs and your state licensing board.

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