How to Get Your COTA License in Texas 2026

How to Become a Licensed OTA/COTA in Texas

Texas is one of the largest and fastest-growing healthcare markets in the nation. With major metropolitan areas in Houston, Dallas–Fort Worth, Austin, and San Antonio, combined with extensive rural and border communities, the demand for Certified Occupational Therapy Assistants (COTAs) spans an extraordinary range of settings and patient populations. This guide walks you through every step of earning and maintaining a COTA license in Texas in 2026.

Step 1: ACOTE-Accredited OTA Program

Texas offers numerous ACOTE-accredited occupational therapy assistant programs across community colleges and technical institutions, making it one of the most accessible states for completing your OTA education close to home. These programs award an Associate of Applied Science (AAS) degree and require approximately two years of full-time study.

The curriculum covers anatomy, kinesiology, therapeutic activity analysis, psychosocial OT, physical rehabilitation, and professional practice standards. Level I fieldwork integrates supervised clinical observation and introductory patient contact throughout the academic curriculum, while Level II fieldwork requires a minimum of 16 weeks of full-time supervised practice in approved OT settings — including hospitals, outpatient clinics, skilled nursing facilities, school districts, and home health agencies. Successful completion of both fieldwork components is required before you can apply to sit for the NBCOT exam.

Step 2: NBCOT COTA Exam

After graduating, you must pass the NBCOT COTA examination to earn national certification. The exam fee is approximately $555, and the test consists of 200 questions administered over four hours at a Prometric testing center. The exam combines multiple-choice and clinical simulation questions to evaluate your readiness to practice as a COTA across diverse settings and patient populations.

Earning the COTA credential from NBCOT is a prerequisite for Texas state licensure. NBCOT requires ongoing Professional Development Units (PDUs) each renewal period to maintain certification, ensuring that all practicing COTAs stay current with evolving evidence and best practices in occupational therapy.

Step 3: State OTA License

Texas licenses occupational therapy assistants through the Texas Board of Occupational Therapy Examiners (BOTE). The application requires submission of your NBCOT score report, official transcripts, a criminal background check, and the licensure fee, typically between $75–$100. Texas has a well-organized online application process, and the board processes applications on a rolling basis.

Texas law requires that all individuals practicing as occupational therapy assistants hold a current, active Texas OTA license. Practicing without a valid license is a violation of the Texas Occupational Therapy Practice Act and carries potential civil and criminal penalties. Employers in Texas verify licensure before allowing patient care activities.

OT Compact Membership

Texas is a member of the Occupational Therapy Licensure Compact (OT Compact), enabling eligible Texas-licensed COTAs to obtain practice privileges in other compact states. Given Texas's size and the large number of COTAs who take travel contracts across the Sun Belt and beyond, compact membership is a significant practical advantage. COTAs licensed in other compact member states can also obtain compact privileges to practice in Texas. Always verify current compact membership status and eligibility requirements through the OT Compact's official resources.

CE Requirements

Texas requires licensed occupational therapy assistants to complete 30 continuing education hours per two-year renewal cycle. CE must be relevant to occupational therapy practice and may include professional conferences, accredited online coursework, formal academic study, and approved in-service training. Texas's 30-hour CE requirement is among the more demanding in the country, so systematic planning of CE activities throughout the renewal cycle is essential. Retain all CE certificates, completion records, and provider documentation in case of a Texas BOTE audit.

Texas COTA Salary Ranges

COTAs in Texas typically earn between $45,000 and $65,000 annually — a range that is notably higher than many states, reflecting Texas's large, competitive healthcare market and higher cost of living in its major metros. Houston, Dallas–Fort Worth, Austin, and San Antonio all offer robust job markets with salaries across the full range. Travel COTAs on temporary assignment in Texas can earn $30–$48 per hour plus stipends, with Houston and Dallas-area contracts often at the higher end of this range during peak demand periods.

Top Employers

Texas's healthcare market is anchored by major regional health systems. Texas Health Resources operates hospitals and outpatient facilities across the Dallas–Fort Worth metroplex and is a leading employer of therapy professionals in North Texas. Baylor Scott & White Health, the largest not-for-profit health system in Texas, employs COTAs across hospitals, clinics, and rehabilitation programs statewide. Texas school districts represent a massive employer base — Texas's large student population and robust special education programs create consistent demand for school-based COTAs in urban, suburban, and rural districts. National post-acute and rehabilitation chains — including Encompass Health, Kindred Healthcare, Genesis Healthcare, and Brookdale Senior Living — operate extensively throughout Texas. Pediatric therapy clinics, home health agencies, and outpatient rehabilitation centers provide additional opportunities across all four major metro areas.