NBCOT

Overview

The National Board for Certification in Occupational Therapy (NBCOT) is the body that certifies occupational therapy practitioners in the United States. It runs two entry-level certification exams: the OTR exam for occupational therapists (Occupational Therapist Registered) and the COTA exam for occupational therapy assistants (Certified Occupational Therapy Assistant).

Certification is not the same as a licence. NBCOT itself says passing its exam is one step, and candidates still need to complete the licensure steps set by their state.

Who can apply

• OTR: you must have graduated with an entry-level occupational therapy degree from a program accredited by ACOTE.

• COTA: you must have graduated with an entry-level degree from an ACOTE-accredited occupational therapy assistant program.

• Internationally educated candidates: if your entry-level degree is not from a U.S.-accredited college or university, you apply through NBCOT's separate eligibility determination process for occupational therapists (OTED) instead.

• All candidates must agree to follow the NBCOT Candidate/Certificant Code of Conduct, and answer character-review questions honestly on the application.

If NBCOT changes its eligibility rules before you are certified, you have three years from your graduation date to test under the earlier rules.

Exam pattern

Both exams are timed, four-hour, computer-based tests taken in person at a Pearson test centre. Each includes some unscored field-test items that NBCOT uses to collect data on new questions.

Syllabus

Exam content is organised into domains, each with a set share of the items.

OTR domains

COTA domains

Each domain has task and knowledge statements, and every item is classified against them. NBCOT publishes a separate exam outline for each credential.

Marking and results

Results are reported on a scale of 300 to 600, and a total scaled score of at least 450 is needed to pass either exam. Scoring is criterion-referenced: you are measured against a fixed competency standard, not against other candidates. The passing standard is set using the Modified Angoff method, and new exam forms are statistically equated so the standard stays consistent.

Exams are scored on set dates listed on the NBCOT scoring calendar. To receive your result on a particular scoring date, you must test at least three days before it. Results appear in your MyNBCOT account.

Fees

The application fee is not stated in the handbook, so check NBCOT's site for the current amount. The handbook lists these other charges, in US dollars, as of its September 2026 edition:

• Reissuing an ATT letter after a late cancellation, late arrival, missing ID or no-show: $115.

• Each score transfer or eligibility confirmation notice beyond the free one included with an application, or requested after applying: $35.

• A duplicate MyNBCOT account: $35.

• Processing fee on any refund: $40. Refunds are given only for duplicate payments, overpayments or approved application withdrawals.

How to apply

1. Read the Certification Exam Handbook in full.

2. Create a MyNBCOT account (once only) and complete your profile and academic information.

3. Answer the character questions and, if you need testing accommodations, submit the request and documents.

4. Submit the online application and pay. The application is valid for 90 days, so apply when you plan to test within that window. Applications made by anyone other than the candidate are invalid.

5. Send your academic verification, such as an official final transcript.

6. Once approved, you receive an Authorization to Test (ATT) letter by email within three business days. It is active for 90 days.

7. Schedule your appointment with Pearson only after you have the ATT letter. You can cancel or reschedule up to 48 hours before it.

If your application expires, you must submit a new one and pay the full fee. An ATT letter can be reissued for a further 90 days only while the application is still unexpired.

After the exam

Candidates who pass are emailed when the result is posted, and then receive information on downloading their digital certificate, badge and wallet card. Those who do not pass receive a feedback report with their overall score and domain-level performance, meant for diagnosis.

Retaking the exam. You must submit a new application and wait before testing again:

• Attempts 2 to 4: 30 days after the previous attempt.

• Attempts 5 to 7: 60 days after the previous attempt.

• Attempt 8 onward: 90 days after the previous attempt.

You can apply up to 30 days before your next eligible date.

Preparation tips

• Study from the published exam outline for your credential, and weight your time by domain share.

• NBCOT sells its own study tools, including the StudyPack ($85 in the handbook), a study guide ($60 printed, $40 electronic) and flashcards ($15).

• Use the waiting period between attempts, if you need one, to review your domain-level feedback.

• Do not copy or share exam content online; this breaches the Code of Conduct.