OTR vs. COTA: What’s the Difference?

If you’re interested in the career of occupational therapy and you are just discovering the differences of the two occupational therapy career paths (OTR vs OTA/COTA), and maybe you aren’t sure which direction to take, then this is post is for you!

You may already be aware there are two paths, becoming an Occupational Therapist (OTR) or a Certified Occupational Therapy Assistant (COTA) but you might not know of the main (and very important) differences. There is a lot to consider when choosing between the two careers.

First, the General Difference Between OTR vs. COTA Careers

What Do OTR, OTR/L, OTA, and COTA Actually Mean?

Before we get into the differences, let’s decode the letters, because the alphabet soup confuses many people at first.

What is OTR?

OTR stands for Registered Occupational Therapist. The “Registered” comes from passing the NBCOT (National Board for Certification in Occupational Therapy) exam after graduating from an accredited OT program. When you see OTR credentials listed after someone’s name, that’s what it signals: an occupational therapist who has completed a master’s or doctoral degree and passed national board certification.

What is OTR/L?

OTR/L adds an “L” for Licensed. Certification and licensure are two separate things: NBCOT certifies you nationally, and your state licenses you to practice. So an OTR/L is a Registered Occupational Therapist who also holds an active state license. Most practicing OTs in the U.S. use OTR/L. You may also see COTA/L, which works the same way.

COTA meaning: COTA stands for Certified Occupational Therapy Assistant. Like the OTR, the “Certified” comes from passing the NBCOT exam for assistants.

OTA vs COTA: is there a difference? This trips up a lot of people, but OTA and COTA refer to the same role. OTA (Occupational Therapy Assistant) describes the profession and the degree program. COTA is the credential you earn once you’ve passed the NBCOT certification exam. So you graduate from an OTA program, sit for boards, and become a COTA. If you see a job posting for an “OTA,” they’re looking for a COTA.

What a Registered Occupational Therapist (OTR) Does

Now that we’ve gotten the basics out of the way, we’ll go more into what a registered occupational therapist (OTR) does. Registration occurs after you pass the national 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 experienced OTs you meet may only have a Bachelor’s degree in Occupational Therapy, but those programs have since been phased out years ago.

The current options are a five year Bachelor’s to Master’s or Doctorate program, or two to three years of graduate school for the Master’s in OT (MOT or MSOT) or Doctorate in OT (OTD) after you already have completed a Bachelor’s degree in any field. These options vary depending on what OT school you are interested in. These degrees are started after you take the program’s required prerequisite courses.

For more on the two types of OT graduate degrees, be sure to check out our article, The MOT vs. OTD: Which Degree Should You Pursue?

What a Certified Occupational Therapy Assistant (COTA) Does

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. If you see the abbreviation OTA for Occupational Therapy Assistant, this is the same thing.

Currently, the educational requirement to become 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.

To learn more about becoming a COTA, our other article, Follow These 8 Steps to Become a COTA, will further help you out.

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

COTAs typically have fewer job opportunities in the hospital, home health 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, when the PDPM Medicare cuts happened in 2019, the job market in SNFs has decreased for COTAs, but there are still SNF COTA jobs out there. COTAs can also find pediatric positions in school systems and outpatient pediatric clinics.

Be sure to do thorough research in your city using online job boards like Indeed to see what the market is like for both OT disciplines, so you can ensure you’ll have 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 a 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 OTA to OTR 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 for the entirety of the program.

Both OT Master’s/Doctorate’s and Associate’s OTA programs can have wait lists due to the high levels of competition, so be sure you have a competitive GPA and a 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 $160,000+ for the whole program.

The Associate’s OTA degree will be considerably cheaper, ranging from $8,000 to $35,000+ depending on whether you go public or private, according to data from EduMed.

Salary Potentials for OTR vs. COTA Careers

With the lower tuition of OTA school does come lower annual income, but the gap may be smaller than you’d expect, and both careers pay well above the national average.

According to the U.S. Bureau of Labor Statistics, the median annual wage for occupational therapists was $100,330 in May 2025, which works out to about $48.24 per hour. The lowest-earning 10% of OTs made under $71,690, while the top 10% earned more than $131,950. 

For occupational therapy assistants, the median annual wage was $72,300 in May 2025,roughly $34.76 per hour at a full-time schedule. The lowest 10% of COTAs earned under $51,490, and the top 10% earned more than $89,780 (BLS).

For context, the median wage across all U.S. occupations was $50,980 in May 2025, so a COTA’s median sits well above the national median, and an experienced COTA in a high-paying setting can out-earn an entry-level OT.

Notice the pattern holds for both roles: home health and skilled nursing pay the most, and school-based practice pays the least, though school settings come with a school calendar and, for many people, better work-life balance.

Job Outlook

Both careers are growing fast. BLS projects employment of occupational therapists to grow 15% from 2025 to 2035, much faster than the 3% average for all occupations, with about 10,000 openings projected each year.

For occupational therapy assistants specifically, projected growth is even higher at 21% over the same period.

Both OTs and COTAs are ranked in the top professions for being AI-proof, which is another aspect to consider when you are choosing a career. I will be writing more about this soon but this is absolutely a plus for choosing either one. 

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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 vice-versa, please share in the comments below! We’d love to learn about how you decided to take that path and what advice you would give prospective students. 

Additional OT School Resources from My OT Spot

How to Get into OT School: Everything You Need to Know 

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

This post was last updated on September 14, 2026.