How to work as an international occupational therapist in the USA 

The United States is a popular destination for international occupational therapists (OTs) who want to relocate for better career opportunities, higher pay and the American way of life. US employers are keen to find skilled and committed healthcare professionals and are increasingly turning to international candidates to support their onshore hiring.  

The demand for candidates from abroad is an exciting opportunity for OTs who are thinking about moving or have been making plans to relocate for a while. As an international recruitment agency, Espirita is here to guide you through the process from start to finish.  

7 steps to become an occupational therapist in the USA 

We’ve broken the process of becoming an occupational therapist in the US into seven key steps for you: 

1. Find an occupational therapist agency 
2. Evaluate your occupational therapy credentials 
3. Take the NBCOT certification exam 
4. Secure an occupational therapy job offer 
5. Apply for your work visa 
6. Obtain state licensure 
7. Relocate to the USA 

1. Find an occupational therapist recruitment agency

Working with a US-based staffing agency can help you navigate the more complex aspects of your occupational therapist relocation journey and help you find the right role in a state you want to live in.  

To register with Espirita, you must: 

• Have a Bachelor’s degree (or foreign equivalent degree) in Physical Therapy or Occupational Therapy from an accredited institution 
• Hold or be eligible for state licensure as an occupational therapist 

We offer personalised one-to-one mentoring and financial guidance to help you secure your US occupational therapy licence and successfully pass the relevant exams. Our experienced immigration lawyers will guide you through every step of the visa process, providing financial advice and making the transition as stress-free as possible for you and your family. 

2. Evaluate your occupational therapy credentials 

Occupational therapists looking to work in the USA must meet the minimum education requirements set out by the National Board for Certification in Occupational Therapy (NBCOT).  

As part of the Occupational Therapist Eligibility Determination process (OTED), your education provider must send a transcript of your course directly to the NBCOT. This step allows the NBCOT to assess your qualifications and credentials alongside any licenses you hold to determine if they meet US standards. If you trained in language other than English, you’ll need to provide certified translations of these documents. 

3. Take the NBCOT certification exam 

Once you’ve finished the OTED process and have completed any required additional coursework, you’ll be eligible to take the NBCOT exam, also known as the OTR exam. Occupational therapists planning to work in the USA must pass the exam to become certified before applying for state licensure. It’s a computer-based test used to assess clinical knowledge and your application of this knowledge using real-world scenarios.  

On the NBCOT exam: 

• Takes average of six weeks to prepare for the NBCOT exam 
• Must achieve passing scores on it within seven years of being approved to take it 
• Possible to retake exam after a 30-day waiting period (additional fees apply) 

4. Secure an occupational therapy job offer 

You need a valid job offer from a US employer before applying for a work visa and moving to the United States.  

Working with an international recruitment agency is one of the most effective ways to secure an occupational therapy position in the USA. Experienced recruiters understand the healthcare sector and have connections with employers who are looking for international candidates, matching you with the best opportunities. 

Espirita specialises in international healthcare recruitment, covering roles in occupational therapy and other professions such as physical therapy and nursing. We have a track record of successfully supporting healthcare professionals in their goal of moving to the United States. Our relocation experts guide you through the key stages of this journey – from applying for state licensure and NBCOT certification to settling into your job.  

5. Apply for your work visa 

Having a visa allows you to work and live in the United States and is an essential step for anyone planning to relocate there. In some circumstances, it allows your family to come along with you too, usually referred to as dependents. 

The type of visa you’re eligible for will depend on your citizenship. Here are examples of visas you may apply to as an occupational therapist: 

• EB-3 visa 
• TN visa 
• E-3 visa
• H-1B temporary work visa 

6. Obtain state licensure 

Once you’ve passed the NBCOT exam, you can start applying for licensure with the board in your chosen state. You should expect to provide: 

1. Completed application form 
2. Licensing fee 
3. Official transcripts/OTED certification 
4. NBCOT exam results  
5. Professional references  

For some states, you may need to meet additional requirements and take a jurisprudence exams. 

Note that many states require a Social Security number (or alternatively an affidavit/ITIN) when submitting your licensure application. You can apply for a Social Security number when progressing through the final stages of your immigration (visa) process, or shortly after arriving in the United States. 

Always remember, requirements differ from state to state and you should familiarise yourself with what is needed in your case. Espirta’s relocation experts can advise you on this before you make an application to avoid unnecessary delays. 

7. Relocate to the USA 

Job offer and visa secured? That’s great news, you’re ready to make the move to the USA. You can choose to wait for your licensure to be granted before you move, but you’re also able to relocate at this stage and wait for your occupational therapist licence to come through while setting yourself up in the United States instead.  

In this final stage of your journey to becoming an OT in the United States, you’ll be: 

• Booking flights and transfers 
• Finding a place to live 
• Registering with schools and doctors 
• Becoming part of your new community

Unlike other recruitment agencies, Espirita remains by your side even once you’ve started your new job. You receive unmatched support from our team – we cover your travel and transfers, schedule regular check-ins and help you integrate into the local community.