To become an occupational therapy assistant (OTA), you'll typically need an associate's degree from an accredited OTA program, several months of supervised fieldwork, and a passing score on the certification exam. Most states then require a state licence. Occupational therapy aides are different: they usually need only a high school diploma and are trained on the job.
Occupational therapy assistants help people relearn everyday tasks after injury, illness or disability, working under an occupational therapist. The title sounds close to an aide, but the training, the licence and the pay are worlds apart. Here's what the US Bureau of Labor Statistics (BLS) handbook said when I read it in October 2026.
Assistant or aide: the difference that decides your pay
| Occupational therapy assistant | Occupational therapy aide | |
|---|---|---|
| Education | Associate's degree from an accredited program (some bachelor's programs) | High school diploma or equivalent |
| Training | Coursework plus several months of fieldwork | On the job, from several days to a few weeks |
| Licence | Usually a state-issued licence | Typically not regulated by state law |
| Median pay (May 2025) | $72,300 | $39,160 |
| Projected growth 2025 to 2035 | 21% | 4% |
| Jobs in 2025 | 52,200 | 4,400 |
That's the single most useful fact on this page. As of October 2026, an assistant earns close to double an aide's median wage, and nearly all the job growth is on the assistant side. If you can manage 2 years of study, the assistant route is the one to take.
How to become an occupational therapy assistant, step by step
- Choose an accredited program. BLS says associate's degree programs generally take 2 years of full-time study, with coursework such as anatomy, psychology and kinesiology.
- Complete your fieldwork. On top of coursework, you must complete several months of fieldwork to gain hands-on experience.
- Pass the exam. You must pass it to use the title Certified Occupational Therapy Assistant (COTA), and you'll need continuing education to keep the certification.
- Get your state licence. Licensure requires an accredited program, fieldwork and the exam, and some states add a background check.
- Add CPR and basic life support. BLS says both assistants and aides may need these certifications.
- Consider a specialty. Optional credentials can show knowledge in an area such as low vision.
What OTAs earn and where the best pay is
As of October 2026, BLS gives a median annual wage of $72,300 for occupational therapy assistants in May 2025. The lowest 10% earned less than $51,490 and the highest 10% more than $89,780. Here's the surprise in the industry figures:
| Industry (US, May 2025) | Median annual wage | Share of OTA jobs (%) |
|---|---|---|
| Home healthcare services | $77,310 | 7 |
| Nursing care facilities (skilled nursing facilities) | $76,780 | 19 |
| Offices of physical, occupational and speech therapists, and audiologists | $70,740 | 39 |
| Hospitals; state, local, and private | $67,020 | 17 |
| Educational services; state, local, and private | $60,920 | 7 |
Therapy offices employ the most OTAs, but home healthcare and skilled nursing facilities pay more. Schools pay the least of the top employers, which matters if you were picturing a school-based role. Most OTAs work full time, though part-time work is common, and evening or weekend sessions can be part of it.
What the job involves
OTAs work with occupational therapists to help clients develop, improve and keep everyday skills. BLS says you could be teaching a client to move from a bed into a wheelchair, leading children with disabilities in play activities, showing someone how to use adaptive devices for meal preparation, or recording progress and reporting back to the therapist. It's physical work: assistants spend much of their time standing, kneeling and stooping, and they sometimes need to lift clients.
Aides do the support work around the therapy instead. BLS says they prepare treatment areas and set up equipment, escort clients to and from sessions, clean equipment, help clients with billing and insurance forms, and handle scheduling and phone calls. It's useful experience, but it's clerical and practical rather than treatment.
The qualities BLS says you'll need
- Adaptability: not every therapy works for every client, so you'll work creatively with the occupational therapist on a new approach
- Compassion: clients are often frustrated by their challenges, and encouragement is part of the job
- Detail: you follow the therapist's written and spoken instructions precisely and record progress carefully
- Interpersonal skills: you're part of an interdisciplinary team as well as the client's main contact in a session
- Stamina and strength: long periods standing, frequent kneeling and stooping, and moderate strength for lifting and moving clients
Job outlook
BLS projects occupational therapy assistant employment to grow 21% from 2025 to 2035, much faster than average, with about 8,600 openings a year across assistants and aides. The driver is an aging population: older adults are more prone to conditions such as arthritis and strokes, and long-term care providers use assistants to keep therapy costs down. Restrictions on insurance reimbursement for aide services are one reason aide growth is so much slower.
Where it can lead
BLS says aides can become assistants with more education and a licence, and assistants can go on to become occupational therapists. My guide on how to become an occupational therapist covers that next step, and if you're weighing up therapy careers, compare it with becoming a physical therapist assistant, which has a similar degree and licence route.
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My verdict
If you want a hands-on healthcare job without years of study, OTA is one of the best value routes there is. Do the accredited associate's degree, take the fieldwork seriously because that's where employers find you, and pass the COTA exam first time. Skip the aide route unless you need a job right now, because the pay gap and the growth gap both point the same way.
Frequently asked questions
How long does it take to become an occupational therapy assistant?
BLS says associate's degree programs generally take 2 years of full-time study, plus several months of fieldwork, before you sit the exam.
Do occupational therapy assistants need a license?
Usually, yes. BLS says OTAs usually need a state-issued licence, which requires an accredited program, fieldwork and passing an exam.
How much do occupational therapy assistants make?
As of October 2026, BLS gives a median annual wage of $72,300 for occupational therapy assistants (May 2025 data).
Can an occupational therapy aide become an assistant?
Yes. BLS says aides may advance to become occupational therapy assistants with additional education and licensure.
What does COTA stand for?
Certified Occupational Therapy Assistant. BLS says you must pass the exam to use the title and keep up continuing education to maintain it.
