Navigating state licensure requirements can be a challenge for occupational therapy practitioners (OTPs) who want to work across state lines. The Occupational Therapy Licensure Compact (OT Compact) is designed to make interstate practice easier while maintaining high licensure standards.
With 31 states having enacted the Compact and implementation expected in late 2025, it’s important for OTPs to understand what the Compact does, how it differs from other licensure processes, and what it means for their practice.
What Is the OT Compact?
The Occupational Therapy Licensure Compact is a joint initiative of the American Occupational Therapy Association (AOTA) and the National Board for Certification in Occupational Therapy (NBCOT®). Modeled after similar licensure compacts for nurses, physical therapists, and other healthcare professionals, it creates an easier pathway for OTPs to practice across state lines while maintaining licensure integrity.
The OT Compact is an agreement between participating states that allows licensed occupational therapists (OTs) and occupational therapy assistants (OTAs) to practice in multiple states through compact privileges, rather than obtaining separate state licenses. A compact privilege is legal authorization to practice in another Compact member state other than the licensee’s home state.
The Basics of Licensing and Certification
To practice occupational therapy, you must be licensed to practice in the state where you work. Currently, all 50 states, Washington, D.C., Puerto Rico, and Guam have licensure requirements for OTPs.
The core licensing requirements that are required across all jurisdictions include:
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Graduating from an ACOTE®-accredited OT or OTA program.
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Completing fieldwork requirements.
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Passing the NBCOT® certification exam.
Interstate Compact vs. Universal License Recognition Law
The OT Compact is an occupational licensure compact, meaning that states opt in to recognize the occupational/professional licenses issued by other states in the Compact. Practitioners who meet the requirements gain a “privilege to practice” in another member state. Some states may require a jurisprudence exam, and member states will be notified if a practitioner is facing disciplinary action.
To gain a Compact privilege, you are first licensed in your home state, and when the Compact is in effect, you’ll be able to apply for a compact privilege to practice in other Compact member states. A Compact privilege provides all of the rights and responsibilities of a full state license.
Some states have Universal license recognition (URL) laws, which allow practitioners to apply for a state license based on an existing license from another state. However, ULR laws still require an application process for each state.
Key Difference: The OT Compact allows for a streamlined process to secure privileges to practice in multiple states through state centralized websites, while ULR requires OTPs to apply for individual licenses in each new state.
Why the OT Compact Is Important
The OT Compact is designed to increase access to high-quality occupational therapy services while making interstate practice more efficient.
For Clients:
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Greater access to OT services across state lines.
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Continuity of care for individuals who move frequently (e.g., military families).
For OTPs:
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Flexibility and mobility—especially for traveling therapists, telehealth providers, and military spouses.
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Reduces licensure burdens for practitioners working in multiple states.
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Aligns with licensing processes in other medical professions, making occupational therapy more adaptable.
For OTPs, the Compact promises flexibility and mobility, for example, spouses of relocating military families or staff of mobile therapy companies. This portability is common in other medical fields and does not compromise the quality of care or the authority of the regulators in each state.
Common Misconceptions About the OT Compact
Myth: “The Compact means I can practice anywhere in the U.S.”
Fact: The Compact only applies to member states. If a state has not joined the Compact, you must apply for a separate license there.
Myth: “Once I have a compact privilege, I don’t need to maintain my home state license.”
Fact: You must maintain an active license in your home state to keep your compact privileges.
Myth: “The Compact automatically includes all OTPs.”
Fact: OTPs must apply for compact privileges to practice in additional states. It’s not automatic.
What’s Next for the OT Compact?
With 31 states already part of the Compact, the OT Compact Commission is currently developing rules and policies. The system is expected to be operational in late 2025 for some states.
How OTPs Can Prepare:
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Stay informed—Follow updates from AOTA and the OT Compact Commission.
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Check your state’s status—See if your state is part of the Compact at OTCompact.org.
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Advocate for expansion—If your state isn’t a member, support advocacy efforts to bring the Compact to more states.
The following materials are helpful when discussing the Compact with your community.
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Fact Sheet: States and the OT Compact discusses the basics of the Compact and the potential benefits while also dispelling myths.
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OTCompact.gov has a tool kit for advocacy and a mailing list that will announce when the interstate licensure applications open.
Stay Updated
The OT Compact is a major step forward for OTPs, making it easier to practice across state lines while maintaining licensure integrity. With full implementation expected in 2025, now is the time to learn how the Compact can impact your practice and prepare for a more flexible future in occupational therapy. Visit AOTA’s OT Compact Advocacy Page for resources on supporting the OT Compact.
