What does an occupational therapy assistant do?
Occupational therapy is about helping people do the things they need and want to do every day. For a child, that might be holding a pencil or managing sensory challenges in class. For an adult after a stroke, it might be getting dressed, cooking a meal or returning to work. For an older adult, it might mean staying safe and independent at home.
Occupational therapy assistants work under the direction of occupational therapists. The OT evaluates the patient and creates a plan. The OTA carries out treatment, often using everyday activities as therapy. That can include practicing self-care skills, doing exercises to build hand strength and coordination, teaching new ways to do tasks, and training patients to use adaptive equipment.
OTAs also suggest changes to a person’s home or workplace, like grab bars or special utensils, and teach family members and caregivers how to help.
Like other therapy jobs, documentation is part of the work. OTAs record what they did, how the patient responded and any changes the OT should know about.
Tools of the job include adaptive equipment, splinting materials, therapy putty, fine motor and sensory tools, kitchen and bathroom training setups, and documentation software.
Occupational therapy assistants work in:
- Schools and early intervention programs
- Nursing homes and skilled nursing facilities
- Hospitals and rehab centers
- Outpatient clinics, including hand therapy
- Home health agencies
A typical day
- Review treatment plans and goals for your patients
- Lead therapy sessions using daily activities and exercises
- Teach patients to use adaptive equipment
- Talk with families or teachers about progress
- Write session notes and update the supervising OT
Occupational therapy assistant pay and job outlook
According to the U.S. Bureau of Labor Statistics, occupational therapy assistants earn a median of $72,300 a year, or $34.76 an hour. Pay often varies by setting, with skilled nursing and home health sometimes paying more than schools.
The BLS counts about 52,200 OTA jobs. Employment is projected to grow 21.5% from 2025 to 2035, much faster than most occupations, with about 8,100 openings each year.
Pros
- Very strong projected growth.
- High pay for a two-year degree.
- Creative work that is different with every patient.
- Many settings to choose from, including schools with summers off.
Cons
- Programs are competitive and include full-time fieldwork, which can be hard if you work.
- The work can be physically demanding, especially in rehab.
- Some settings have high caseloads and productivity targets.
- Progress can be slow, which can be frustrating for patients and therapists.
Training options: an accredited degree is required
There is no apprenticeship route to becoming an OTA. To take the NBCOT exam, you must graduate from an ACOTE-accredited program.
Associate degree. Most OTA programs are offered by community and technical colleges and take about two years. They include classroom courses, hands-on labs, Level I fieldwork experiences and at least 16 weeks of full-time Level II fieldwork.
Bachelor’s degree. ACOTE also accredits some bachelor’s-level OTA programs. These take longer and add more coursework.
Costs vary widely, from several thousand dollars at some public community colleges to $40,000 or more at private schools.
Getting experience first. Working as a rehab aide or volunteering in therapy settings can help you decide if the field is right for you and can strengthen your application.
Certification and licensing by state
Nearly every state regulates occupational therapy assistants, usually through a license. The basic steps are:
- Graduate from an ACOTE-accredited OTA program
- Complete all required fieldwork
- Pass the NBCOT COTA exam
- Apply for your state license and meet any extra state requirements
Supervision rules vary by state. Some states set how often the OT must meet with the OTA or see the patient. Continuing education and renewal rules also vary.
The Occupational Therapy Licensure Compact is being put in place to let practitioners licensed in one member state work in others. Check its current status if you plan to work in more than one state.
Specializations and where they lead
- School-based OTA. Help children build skills for learning, handwriting and self-care.
- Geriatrics and skilled nursing. Help older adults stay independent and safe.
- Physical rehab. Work with patients recovering from strokes, injuries and surgeries.
- Mental health. Help people build daily living and coping skills, a smaller but growing area.
- Leadership or occupational therapist. Experienced OTAs can lead rehab teams, teach, or go back to school to become occupational therapists. Some schools offer bridge programs for working OTAs.
How to choose an OTA school
The right program gets you through the NBCOT exam and ready for real therapy work. Ask these questions:
- Is the program accredited by ACOTE? You cannot take the NBCOT exam without it.
- What are your NBCOT pass rates and graduation rates? Accredited programs share outcome data.
- Where do students complete fieldwork? Ask about the variety of settings and how placements are made.
- What are the admission requirements? Ask about prerequisites, observation hours, GPA and waitlists.
- What is the total cost? Include books, lab fees, fieldwork travel and exam fees.
- How do fieldwork schedules work? Level II fieldwork is full time, so plan your work and family schedule.
- What job placement help do you offer? Ask where recent graduates work.
