Occupational Therapy Assistant (OTA): What They Do, How to Become One and Salary
Occupational therapy assistant career guide: duties, how to become a COTA, NBCOT exam, 2025 salary and outlook, supervision and career ladder.
What is an occupational therapy assistant (OTA) or COTA?
A certified occupational therapy assistant is an individual who works under the guidance and supervision of an occupational therapist and may assist in the evaluation, program planning and treatment processes (AOTA).
The occupational therapist (OT), the occupational therapy assistant (OTA) and the occupational therapy aide all work in the occupational therapy profession. Read more: what is occupational therapy?
An OTA and a COTA are the same role, and people use the terms interchangeably. But an OTA cannot use the term COTA until they pass the certification exam. COTAs use the word “certified” because they are certified by the National Board for Certification in Occupational Therapy (NBCOT). NBCOT owns the designations Certified Occupational Therapy Assistant (COTA) and Occupational Therapist Registered (OTR), and people not certified by NBCOT cannot use these credentials. Because renewing NBCOT certification is voluntary in many states once licensed, not every practising OT is an OTR and not every OTA is a COTA.
OTA job at a glance
| Occupational therapy assistant | |
|---|---|
| Median pay (BLS, May 2025) | $72,300 per year |
| Entry-level education | Associate's degree from an accredited OTA program |
| Exam and licence | NBCOT COTA exam; state licence usually required |
| Number of US jobs (2025) | About 52,200 |
| Job outlook 2025–2035 | +20% (OTAs and aides combined), much faster than average |
| Openings per year | About 8,600 (OTAs and aides combined) |
| Largest employer | Offices of physical, occupational and speech therapists and audiologists (39%) |
| Stress level | Average; physically active work |
Source: US Bureau of Labor Statistics, Occupational Outlook Handbook. Salary depends on experience, location and work setting.
Duties of an occupational therapy assistant
- Help clients do therapeutic activities, such as stretches, hand exercises and practising daily tasks
- Encourage clients to complete activities and tasks
- Teach clients and caregivers how to use special equipment, such as a reacher or tub bench
- Lead children with developmental disabilities in play and sensory activities
- Contribute to evaluation by gathering data and reporting observations
- Provide treatment according to the OT’s intervention plan
- Record client progress, report to the OT and handle related administrative work
How to become an occupational therapy assistant
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High school diploma
Science courses like biology and health help; volunteer or shadow in OT if you can.
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Accredited OTA program
An ACOTE-accredited associate's degree, about 2 years; some colleges offer a bachelor's.
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Fieldwork
Level I fieldwork plus at least 16 weeks of full-time Level II fieldwork in real practice settings.
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NBCOT exam
Apply and pass the COTA certification exam.
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State licence
Apply for a licence in the state where you'll work, and keep up continuing education.
Occupational therapy assistants graduate from programs accredited by the Accreditation Council for Occupational Therapy Education (ACOTE). These programs are offered at community colleges and universities across the United States. Check fieldwork hours and exam eligibility with ACOTE and NBCOT, as standards are updated periodically.
Practice areas
Occupational therapy assistants work in many health care settings and are in good demand in skilled nursing facilities and nursing homes, schools, rehabilitation centres, general hospitals, home health and psychiatric hospitals. The conditions OTAs most often see include stroke and hemiplegia, autism, developmental delay, schizophrenia, cerebral palsy, joint replacement and dementia.
Supervision
The occupational therapist supervises the OTA in evaluation and intervention. This supervision should be collaborative and respectful, not hierarchical. AOTA’s supervision guidelines stress these points:
- Delivering intervention under OT supervision is the OTA’s primary role.
- An OTA may not conduct an evaluation or begin treatment independently before the OT’s evaluation.
- The OTA contributes to evaluation by reporting observations, current level of functioning and impairment, and gathering related data.
- The OT is responsible for the outcome of all occupational therapy services provided by the OTA.
- The frequency, amount and type of supervision vary with the OTA’s experience, the setting and the client’s needs, and must follow state law and payer rules.
Read more about supervision levels in OT vs OTA.
Collaboration
The most important part of the OT–OTA relationship is collaboration and ongoing effort on both sides. It must be active and interactive. Good collaboration and team building contribute to the professional growth of both, improve mutual respect, and lead to better performance and personal and professional growth.
Service competency
An OTA can expand their role by establishing service competency: the ability to use a specified intervention in a safe, effective and reliable manner, so that the OT and OTA can perform the same or equivalent procedure and obtain the same results. OTAs who establish service competency don’t become independent; they continue to work under the supervision of an occupational therapist.
Specific roles of an OTA
An occupational therapy assistant can take on many roles, always under the supervision of an OT where client services are involved:
| Role | What it involves |
|---|---|
| Practitioner | Provides quality OT services to assigned clients, from entry level to advanced depending on experience, education and skills. |
| Educator | Teaches clients, caregivers and community groups about occupational therapy topics. |
| Fieldwork educator | Supervises Level I students at entry level; with at least one year of experience, supervises OTA Level II students. |
| Manager | Manages the daily operation of OT services in a defined practice area. |
| Consultant | Advanced OTAs may consult to individuals, groups or organisations; this is mainly an OT role. |
| Faculty | With an appropriate advanced degree and teaching skills, teaches in OTA or OT programs. |
| Researcher | Contributes to research; additional qualifications are needed to be a principal investigator. |
| Entrepreneur | May be partly or fully self-employed if state regulations allow, while obtaining appropriate OT supervision for direct services. |
The COTA career ladder
How much supervision a COTA needs depends on their level of expertise and experience. Entry-level COTAs need more direct supervision; experienced COTAs need less.
Most responsibility ↑
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Advanced levelSenior
Improved technical competency in a specific area; greater responsibility for program planning and implementation. May be a senior staff member (OTA II), co-present research at conferences and modify or make adaptive devices. Responsibilities approach those of an OT, but the OT keeps official responsibility.
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Intermediate level1+ year
After about a year of practice, supervision shifts from close to routine or general. Evaluation tasks and treatment are carried out more independently, and the OTA may supervise OTA fieldwork students.
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Entry levelNew grad
Less knowledge of the setting, so less responsibility and more supervision. Provides client education, carries out treatment set by the OT (e.g. cognitive and self-care training), learns practical skills from the OT, adapts activities to client needs, and learns independent problem solving.
Least responsibility
Skills and qualities for OTAs
- Physical fitness: OTAs support and transfer clients, which takes a lot of energy. Good physical strength makes the work easier and safer.
- Problem-solving ability: OTAs make decisions about client issues during treatment, and improve these skills with guidance from the OT.
- Critical thinking: just following instructions isn’t enough. Good OTAs think about client care and progress, suggest better activities and discuss them with the OT.
- Patience: rehabilitation takes time, and full or partial recovery can’t always be expected in a month or two. Patience keeps the OTA hopeful and positive.
- Good communication: OTAs work with clients, caregivers, colleagues, doctors and more.
From OTA to OT
If an OT assistant wants to become an occupational therapist, they can join a transition or bridge program. Some programs are designed for working OTAs, with weekend, hybrid or distance learning. AOTA keeps a list of programs for OTAs seeking an OT degree.
Future growth
The occupational therapy profession is in high demand. BLS projects OTA and aide employment to grow 20% from 2025 to 2035, much faster than average. As OTs take on more consultation, supervision, program development and research, the roles of occupational therapy assistants will continue to grow too. Read more: OT vs OTA.
Summary
The role of the OT assistant is continually evolving. Effective collaboration and teamwork between OTs and OTAs help solve staff shortages and provide high-quality, cost-effective services to meet ever-increasing demand for occupational therapy.
References
- US Bureau of Labor Statistics. Occupational Outlook Handbook: Occupational Therapy Assistants and Aides.
- Sladyk K, ed. Ryan’s Occupational Therapy Assistant: Principles, Practice Issues, and Techniques. 5th ed. SLACK; 2014.
- Johnson JA, ed. Certified Occupational Therapy Assistants: Opportunities and Challenges. Routledge; 2013.
- American Occupational Therapy Association. Guidelines for supervision, roles, and responsibilities during the delivery of occupational therapy services. 2020.
- Accreditation Council for Occupational Therapy Education. ACOTE Standards.
Frequently asked questions
What does an occupational therapy assistant do?
How do I become an occupational therapy assistant?
How much does an occupational therapy assistant make?
Is OTA a good career?
What is the difference between an OTA and a COTA?
Where do occupational therapy assistants work?
Written by
Payal Mehta, OT
Payal Mehta is a practising occupational therapist and co-founder of Occupational Therapy OT. She writes on pediatrics, sensory integration, and mental-health practice.
All articles by Payal →This article is for general education and is not a substitute for individualized assessment or treatment by a licensed occupational therapist. Always seek the guidance of a qualified professional for specific concerns.
