OTR vs. COTA: What’s the Difference?

If you’re interested in the career path of occupational therapy and you are just discovering the differences of the two occupational therapy career paths, this post is for you!

You may already be aware there are two paths, becoming an Occupational Therapist (OTR) or a Certified Occupational Therapist (COTA) but you might know of the main (and important) differences. There is a lot to consider when choosing between the two.

First, the General Difference Between OTR vs. COTA Careers

Registered Occupational Therapist (OTR)

To start with the basics for those of you who are not yet fully aware of the difference, the OT(R) stands for Registered Occupational Therapist. Registration occurs after you pass your boards following graduate school, and requires at least a two and a half to three year Master’s or Doctorate degree in Occupational Therapy.

Some seasoned OTs you meet may have a Bachelor’s degree in Occupational Therapy, but those programs have been phased out years ago. The other option is a five year Bachelor’s to Master’s or Doctorate program. Whether or not this option is available depends on the school and does not take into account prerequisite courses.

Certified Occupational Therapy Assistant

The COTA stands for Certified Occupational Therapy Assistant. The “Certified” part is added to your title after you pass the COTA boards following your program. Currently, the educational requirement to be a COTA is a two year Associate’s degree. It does not require a Bachelor’s degree, whereas the Occupational Therapist (OTR) Master’s or Doctorate degrees do.

Differences in Responsibilities

As an OTR you will:

  • Perform patient evaluations
  • Create the patient’s plan of care with goals
  • Complete weekly or progress notes
  • Complete the discharges
  • Provide treatments for your patients

As a COTA you will:

  • Follow the OTR’s treatment plan
  • Carry out interventions (treatments) in line with the OTR’s patient goals
  • You will not complete the evaluation/discharge paperwork
  • Write daily notes which entail what you worked on with the patient and everything that went on in your treatment

Job Opportunities

COTA’s typically have fewer job options in the hospital and outpatient settings. If you are set on working in inpatient rehab or acute care, going for your OTR degree would be your best bet. However, COTAs are commonly in demand at skilled nursing facilities.

However, following the PDPM Medicare cuts in 2019, the job market in SNFs has decreased for COTAs. COTAs can also find pediatric positions in school systems and clinics.

Be sure to do thorough research in your city using online job boards to see what the market is like for both disciplines, so you can ensure a job after graduation.

Educational Requirements

Since the OTR is a Master’s or Doctorate degree, you will spend more time in school (approximately 5-7 years total including Bachelor’s degree). To become a COTA, you will likely need 2 years of schooling if you do not have a Bachelor’s degree.

If you already have a Bachelor’s degree, it will take you the same amount of time to get your Master’s, so it may be a better choice for you to go for the Master’s.

If you do decide that you want to pursue your OTA degree, you can always go back to school later on to get your Master’s and become an OTR. There are many bridge programs that hold classes every other weekend so you can work during the week as a COTA, and still get your Master’s.

If you go straight in to your Master’s or Doctorate full time, you will have little to no time to work while completing your coursework.

To become a COTA, you are learning a lot of the same information in a condensed amount of time. Just because it’s an Associate’s degree doesn’t mean it won’t be a tough program. You will definitely still have to buckle down.

Both Master’s/Doctorate and Associate’s OTA programs can have wait list due to the high levels of competition, so be sure you have a competitive GPA and strong application.

Cost of Schooling

You will also spend quite a bit more on tuition getting your OT Master’s or Doctorate. Averages for the OT Master’s or Doctorate degrees are anywhere between $60,000 to over $150,000 for the whole program.

The Associate’s OTA degree will be considerably cheaper, ranging from $5,000 to $24,000 depending on whether you go public or private, according to data from EduMed.

Salary Potentials for OTR vs. COTA Careers

With the cheaper tuition of OTA school does comes less annual income.

Based on our comprehensive OT and COTA salary findings, we found that the average hourly rate for full time OTs in the U.S. is $36.84/hour. This is the average across all settings, locations, years of experience, and education levels. Assuming a typical 40 hour work week while taking off four weeks per year, the average annual occupational therapist salary works out to be approximately $70,732/year.

The average hourly rate for full time COTAs in the U.S. is $27.65/hour. This also includes all settings, locations, years of experience, and education levels. Assuming the same 40 hour work week as above, the average annual COTA salary averages to be $53,088 per year.

Summary of Differences

otr vs cota chart 2021


We hope this article helps you get a basic idea of some of the main differences between the OTR vs. COTA career paths.

The best choice is the one that you feel will work best for you given your life circumstances. Whatever you decide, be sure to take a good look at the job market in your area, tuition rates, accreditation, curriculum, and program length to make sure you get the best fit for you.

If you have anything to add about your experience considering becoming an OTR vs a COTA or vise-versa, please share in the comments below! We’d love to learn about how you decided to take that path.

This post was originally published on June 19, 2016 and updated on March 2, 2021.

Additional Resources from My OT Spot

7 Steps to Get Into Occupational Therapy School

What are the Pros and Cons of Being a COTA?

Should You Transition From COTA to OTR? The Pros and Cons of Making The Leap

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  • Amanda May 14, 2018   Reply →

    COTAs do progress notes as well, and honestly my schooling was at least 20,000 though the associates and OTA program was incorporated together. It was a fast track program, still 2 years, but why it was longer. Though according to my OTA professor, she had to obtain an associates in the program she was at before entering in the OTA program. Plus, the salary is different than what is being stated, it is more, though this also depends on what state your in….

    • Sarah Stromsdorfer, OTR/L May 17, 2018   Reply →

      Thanks so much for your input, Amanda! I agree that each school and state will have different rates so it is best for those still in the deciding process to do some extra research before making a decision.

  • Traci Brossfield July 14, 2018   Reply →

    I would like to know how much harder the board test is for a COTA than a full OTR board test. My daughter is an OTA and can’t seem to pass the board! She also needs to get her Masters- but wondering how much harder that board test will be or if it’s not that much harder?

    • Sarah Stromsdorfer, OTR/L July 14, 2018   Reply →

      I can’t speak for the COTA exam as I haven’t taken it myself but I would imagine the OTR exam would likely be similar in difficulty, possibly more challenging. I wrote this article after interviewing NBCOT test takers that previously failed the exam that provides actionable tips for next time. I hope this helps! So You Failed the NBCOT? Get Advice To Succeed On Your Next Try

  • Mindy February 14, 2019   Reply →

    I am currently enrolled in the OTA program at Bryant and Stratton. My tuition will cost around 60k when I complete the program. Although this is extremely expensive for an Associate degree, there was no waiting list.

  • Jason July 16, 2021   Reply →

    I am curious if an OTR was burned out and wanted to look for a COTA position, would that be allowed?

    • Sarah Stromsdorfer, OTR/L July 19, 2021   Reply →

      Unfortunately you wouldn’t be able to work as a COTA if you aren’t licensed as one, but the positions could be flexible in hiring an OTR instead of a COTA.

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