How to Get Your COTA License in Maryland (2026 Guide)

## How to Become a Licensed OTA/COTA in Maryland Maryland is home to some of the nation's most prestigious healthcare institutions, and its Certified Occupational Therapy Assistants (COTAs) benefit from a strong job market spanning world-class academic medical centers, large suburban hospital networks, a robust public school system, and thriving home health and outpatient sectors. The Baltimore-Washington corridor is one of the most competitive and well-compensated OTA markets in the country. ### Step 1: Complete an ACOTE-Accredited OTA Program Maryland OTA licensure begins with completing an ACOTE-accredited OTA program. The Accreditation Council for Occupational Therapy Education (ACOTE) accredits two-year Associate of Applied Science (AAS) OTA programs at community colleges and health profession schools throughout the state. Maryland programs include institutions in the Baltimore metro, Washington suburbs, and the Eastern Shore. These programs cover occupational therapy theory, anatomy and physiology, activity analysis, therapeutic interventions across the lifespan, psychosocial practice, and professional ethics. ACOTE mandates at least 16 weeks of combined Level I and Level II fieldwork. Level II fieldwork involves full-time supervised clinical placements. Maryland students have exceptional access to fieldwork sites including Johns Hopkins-affiliated facilities, University of Maryland Medical System hospitals, MedStar Health sites, pediatric specialty centers, and Montgomery and Prince George's County school districts. ### Step 2: Pass the NBCOT COTA Exam After graduating, you must pass the NBCOT COTA examination before applying for Maryland licensure. The exam costs approximately $555 and consists of 200 questions administered over four hours at a Prometric testing center. The exam evaluates clinical reasoning, therapeutic intervention knowledge, activity analysis, ethical practice, and occupational therapy theory. NBCOT credential maintenance requires 36 Professional Development Units (PDUs) every three years. PDU requirements are fulfilled through CE coursework, professional leadership, mentorship, and research activities. Your NBCOT certification renewal is separate from your Maryland state license renewal. ### Step 3: Apply for Your Maryland OTA License Maryland OTA licensure is regulated by the **Maryland Board of Occupational Therapy Practice**. After passing the NBCOT exam, you submit your application to the Board. The application fee is approximately $75–$100. Required documentation includes NBCOT exam verification, official program transcripts, and completion of a criminal background check. Maryland's OT Practice Act defines COTA supervision requirements, scope of practice, and documentation standards. Review these provisions carefully before beginning practice. Maryland does not currently require a separate jurisprudence exam for initial licensure, but check with the Board at time of application for any updates. Maryland OTA licenses renew biennially. ### OT Compact Membership Maryland is a member of the OT Compact, the multistate practice agreement that allows Maryland-licensed COTAs in good standing to obtain practice privileges in other member states. This is particularly relevant given Maryland's location adjacent to Virginia, West Virginia, Delaware, and Pennsylvania (and proximity to Washington, DC), where COTAs may work across state lines. Compact membership has expanded significantly since 2023–2024. ### Continuing Education Requirements Maryland requires **20 continuing education hours per two-year renewal cycle**. CE must be relevant to occupational therapy practice and may cover geriatrics, pediatrics, neurological rehabilitation, ergonomics, assistive technology, mental health OT, and other specialty areas. The Maryland Occupational Therapy Association (MOTA) and AOTA both offer CE programming that satisfies Maryland renewal requirements. Retain CE completion documentation for at least five years for audit purposes. ### Maryland COTA Salary Ranges Maryland COTAs typically earn between **$42,000 and $62,000 per year**, though the Baltimore and DC suburb markets often push compensation above this national average. Hospital-based COTAs at Johns Hopkins, UMMS, and MedStar affiliates are among the best-compensated in the state. Home health COTAs in the Baltimore–Washington corridor can also earn competitive rates due to high patient volume and productivity structures. Travel COTAs in Maryland earn approximately **$30–$48 per hour**, with housing and travel allowances. Demand for travel COTAs exists primarily in rural western Maryland, the Eastern Shore, and southern Maryland counties with thinner permanent staffing. ### Top Employers Maryland's top COTA employers include **Johns Hopkins Medicine**, one of the world's most renowned health systems, with comprehensive inpatient, outpatient, and home health rehabilitation services. The **University of Maryland Medical System (UMMS)** and **MedStar Health** are also major hospital network employers offering COTAs positions in a variety of clinical settings. **Maryland school districts** — including Montgomery County Public Schools, Prince George's County Public Schools, Baltimore City Public Schools, and suburban systems — are large employers of school-based COTAs. **Kindred Healthcare**, **Genesis HealthCare**, **Brookdale Senior Living**, and **Encompass Health** operate skilled nursing and inpatient rehab facilities throughout the state. Home health agencies and pediatric therapy groups round out a rich employer landscape.