Occupational therapist vs occupational therapy assistant
According to BLS, occupational therapists typically need a master’s degree and must be licensed in every state, while occupational therapy assistants typically need an associate’s degree from an accredited OTA program and usually need a state-issued license. NBCOT certifies the two roles separately, as OTR and COTA.
Quoted from official pages checked November 10, 2026. Confirm current requirements, fees, and dates on those sites. This page is not legal advice and does not guarantee eligibility, certification, or licensure.
| Official fact | Occupational therapist (OTR) | Occupational therapy assistant (COTA) |
|---|---|---|
| What BLS says they do | “Occupational therapists evaluate and treat people who have injuries, illnesses, or disabilities.” | “Occupational therapy assistants help occupational therapists provide treatments and procedures to clients.” |
| Typical education (BLS) | “Occupational therapists typically need a master’s degree in occupational therapy to enter the occupation.” | “Occupational therapy assistants typically need an associate’s degree from an accredited program, although some bachelor’s degree programs also are available.” |
| ACOTE directory levels | OT Masters, OT Doctorate (ACOTE directory) | OTA Associate, OTA Baccalaureate (ACOTE directory) |
| NBCOT eligibility (U.S.-educated) | “OTR candidates must graduate with an entry-level occupational therapy degree from an ACOTE®-accredited occupational therapy (OT) program” | “COTA candidates must graduate with an entry-level occupational therapy degree from an ACOTE®-accredited occupational therapy assistant (OTA) program.” |
| Credential title (BLS) | “Therapists must pass the qualifying exam to use the title ‘Occupational Therapist Registered’ (OTR).” | “Occupational therapy assistants must pass the exam to use the title ‘Certified Occupational Therapy Assistant’ (COTA).” |
| Licensure (BLS) | “All states require occupational therapists to be licensed.” | “Occupational therapy assistants usually need a state-issued license.” |
| 2025 median pay (BLS) | $100,330 per year | $72,300 per year (assistants only) |
| Projected growth, 2025–35 (BLS) | 15 percent | 21 percent (assistants only, from the BLS projections table) |
BLS figures are from the occupational therapists and occupational therapy assistants and aides handbook pages, checked November 10, 2026. On that date, both pages showed “Last modified date: August 27, 2026”. The assistant figures here are BLS’s assistant-only numbers, not the combined assistant-and-aide Quick Facts. See OTA pay and outlook for the combined and aide figures, labeled.
How the roles work together, in official words
NBCOT’s What is an OTR or COTA professional? page states that the OTR professional evaluates the client, plans therapeutic interventions, completes discharge documents, and provides clinical supervision of the COTA professional, and that the COTA professional implements and documents the therapeutic interventions and provides feedback to the OTR professional on the client’s progress during treatment.
BLS states on its occupational therapists page: “Occupational therapists also oversee the work of occupational therapy assistants and aides.” On its assistants and aides page, BLS states: “Occupational therapy assistants are part of an interdisciplinary team that includes occupational therapists and other healthcare specialists.”
Supervision rules for assistants are set by each jurisdiction. Confirm them on the board site through the state and territory directory.
Moving from OTA to OT
BLS states: “Occupational therapy assistants may advance by gaining additional education and becoming occupational therapists.” That still means graduating from an ACOTE-accredited OT program and meeting NBCOT’s OTR eligibility. See how to choose an accredited program.
Assistants are not aides
BLS covers occupational therapy aides on the same handbook page, but describes a different job: “Occupational therapy aides typically need a high school diploma or equivalent and receive training on the job.” It also states: “Occupational therapy aides typically are not regulated by state law.” This site’s career pages cover the OTA/COTA path, not the aide job.