A step-by-step guide for starting your Occupational Therapy career in the United States.
Are you a Canadian Occupational Therapist thinking about working in the United States?
The TN visa gives qualified Canadian citizens a practical pathway to work as Occupational Therapists in the USA. However, the visa is only one part of the process.
Before heading to the border, Canadian OTs will generally need to complete an education review, pass the NBCOT examination, obtain state licensure, secure a VisaScreen Certificate, and receive a qualifying job offer from a U.S. facility.
It may sound like a small mountain of paperwork, but the process becomes much easier when you tackle it in the right order.
Can Canadian Occupational Therapists Work in the USA?
Yes.
Occupational Therapist is an eligible profession under the TN visa category. Canadian citizens who meet the education, certification, licensing, immigration, and employment requirements may qualify to work in the United States under TN status.
To qualify, you will generally need:
- Canadian citizenship
- An Occupational Therapy degree
- NBCOT certification
- A licence in the state where you will work
- A VisaScreen Certificate
- A qualifying job offer from a U.S. employer
- A TN support letter and supporting documents
Canadian permanent residents are not eligible for TN status unless they later become Canadian citizens.
Occupational Therapist Salary Comparison: Canada vs USA
Compensation is one reason many Canadian Occupational Therapists consider opportunities in the United States.
The Government of Canada Job Bank reports that Occupational Therapists in Canada generally earn between approximately $36.17 and $55.00 CAD per hour. Wages vary by province, employer, experience, and practice setting.
According to the U.S. Bureau of Labor Statistics, the median annual wage for Occupational Therapists was $98,340 USD ($47.28 USD per hour)Â in May 2024.
Employment for Occupational Therapists is also projected to grow faster than the average for all occupations, which means demand is expected to remain strong.
Salary should not be reviewed on its own. Canadian OTs should also compare:
- Housing and cost of living
- State and federal taxes
- Health insurance
- Retirement benefits
- Sign-on bonuses
- Relocation assistance
- Paid time off
- Continuing education benefits
- Exchange rates
The U.S. salary may look larger, but every relocation deserves a calculator and probably one very organized spreadsheet.
Benefits of Working in the USA as a Canadian Occupational Therapist
Depending on the facility and location, a U.S. Occupational Therapy position may offer:
- Competitive U.S. compensation
- Sign-on or commitment bonuses
- Relocation assistance
- Comprehensive health and retirement benefits
- Continuing education assistance
- Experience in different clinical environments
- Opportunities for specialization
- Long-term professional growth
- Experience within the U.S. healthcare system
Occupational Therapists may work in:
- Acute care hospitals
- Inpatient rehabilitation facilities
- Outpatient clinics
- Skilled nursing facilities
- Long-term care
- Home health
- Mental health programs
- Paediatric settings
- School systems
- Hand therapy and specialty rehabilitation
The Step-by-Step Process for Canadian Occupational Therapists
Confirm Your TN Visa Eligibility
Before investing time and money in the process, confirm that you meet the basic requirements.
You will generally need to:
- Be a Canadian citizen
- Hold an Occupational Therapy degree
- Meet NBCOT eligibility requirements
- Qualify for state licensure
- Obtain a VisaScreen Certificate
- Receive a qualifying U.S. job offer
You should also review the requirements of the state where you want to work. Occupational Therapy licences are issued by individual state licensing boards, and the requirements are not identical across the country.
Complete the NBCOT OTED Eligibility Process
Canadian Occupational Therapy graduates are considered internationally educated by NBCOT because their degrees were completed outside the United States.
Before applying for the NBCOT examination, internationally educated Occupational Therapists must complete the Occupational Therapist Eligibility Determination process, commonly called OTED.
What Does OTED Review?
The OTED process evaluates whether your academic education is comparable to the education required of an entry-level Occupational Therapist in the United States.
NBCOT may review:
- Your Occupational Therapy degree
- Official academic transcripts
- Course descriptions
- Clinical placement or fieldwork documentation
- Educational program information
- Other supporting academic records
Professional experience generally does not replace missing academic requirements because OTED focuses on your entry-level education.
Start gathering detailed course descriptions and fieldwork information early. Universities are lovely places, but document requests do not always move with Olympic speed.
Review NBCOT eligibility requirementsApply for and Pass the NBCOT Examination
Once NBCOT confirms that you meet the educational eligibility requirements, you can apply for the Occupational Therapist Registered examination.
Passing the NBCOT examination allows you to earn the OTR credential, provided you meet all certification requirements.
What Does the NBCOT Exam Cover?
The exam assesses entry-level knowledge and clinical reasoning in areas such as:
- Evaluation and assessment
- Treatment planning
- Intervention selection
- Patient safety
- Professional standards
- Clinical decision-making
- Occupational performance
- Ethics and evidence-based practice
Your school will normally need to send an official final transcript showing your degree title and graduation date.
Review NBCOT examination informationIt is important to understand that NBCOT certification and state licensure are not the same thing.
NBCOT provides national certification. The state licensing board gives you the legal licence required to practise Occupational Therapy in that state.
Apply for State Occupational Therapy Licensure
After passing the NBCOT examination, you can apply for an Occupational Therapy licence in the state where you plan to work.
Requirements vary by state but may include:
- NBCOT examination results
- Proof of NBCOT certification
- Official transcripts
- Credential or education review
- Verification of Canadian registration or licensure
- Criminal background check
- Fingerprinting
- Jurisprudence examination
- Application fees
- Proof of good professional standing
Some states may allow you to begin the application before your NBCOT results are available, but the licence usually cannot be finalized until all required documents are received.
Review the state board requirements before beginning. Documents accepted by one state may not automatically be accepted by another. U.S. licensing boards enjoy variety.
Apply for a VisaScreen Certificate Through TruMerit
Occupational Therapists generally need a healthcare worker certificate before receiving TN status.
VisaScreen is administered by TruMerit, formerly known as CGFNS International.
What Does VisaScreen Review?
VisaScreen may include verification of:
- Occupational Therapy education
- Academic records
- Professional registration and licences
- Professional standing
- NBCOT certification
- English-language proficiency, when applicable
VisaScreen also includes an assessment of whether your education is comparable to that of a U.S. graduate in the same profession.
Review VisaScreen information through TruMeritShould You Start VisaScreen Before or After the NBCOT Exam?
The best approach is to start gathering VisaScreen documents early, but expect the final certificate to depend on your completed professional credentials.
You can begin early by arranging:
- Official transcripts
- Academic records
- Licence verifications
- Identity documents
- English-language test results, if required
However, NBCOT certification and licensing information may still be needed before TruMerit can complete its review and issue the final VisaScreen Certificate.
In simple terms, start the paperwork early, but expect final approval later in the process.
How Long Does VisaScreen Take?
Processing time depends on how quickly TruMerit receives complete and acceptable documentation.
Applicants should allow several months. Delays commonly happen when:
- Universities are slow to send records
- Licensing organizations do not submit verifications
- Course information is incomplete
- Documents contain inconsistent names
- English-language test results are missing
- Additional information is requested
A VisaScreen Certificate is generally valid for five years from the date it is issued.
Secure a Job Offer from a U.S. Facility
Once you are licensed or clearly eligible for licensure and progressing through VisaScreen, you can begin pursuing U.S. Occupational Therapy opportunities.
The position must be a genuine Occupational Therapist role that aligns with the TN professional category.
Your U.S. employer will generally need to provide employment documents that include:
- The employer’s name
- The position title
- Occupational Therapist duties
- The work location
- Compensation
- The anticipated employment period
- Your professional qualifications
IntelliStaff Medical can help qualified Canadian Occupational Therapists connect with U.S. healthcare facilities that are hiring.
The facility, not IntelliStaff Medical, will employ the successful candidate and provide the qualifying job offer.
IntelliStaff Medical can also help you understand the process, organize your next steps, and prepare for conversations with potential employers.
Apply for Your TN Visa
Canadian citizens may generally apply for TN status at a designated U.S. land port of entry or participating airport pre-clearance location.
You will typically bring:
- A valid Canadian passport
- The employer’s TN support letter
- Job offer documentation
- Your Occupational Therapy degree
- NBCOT certification
- Your state licence or proof of licensing eligibility
- Your VisaScreen Certificate
- Your résumé
- Professional registration documents
- Supporting academic records
- Applicable fees
Admission is decided by U.S. Customs and Border Protection. A job offer does not automatically guarantee TN approval.
Make sure the duties in the employer’s letter clearly describe an Occupational Therapist role and match your qualifications.
Bring Your Spouse and Children to the USA
A Canadian Occupational Therapist admitted in TN status may be accompanied by an eligible spouse and unmarried children under the age of 21.
Eligible family members generally apply for TD status.
Dependants in TD status may:
- Live in the United States
- Attend school
- Study full-time or part-time
A spouse in TD status is not authorized to work in the United States.
Families should consider employment plans, health insurance, schooling, housing, and relocation costs before moving.
Apply for a Social Security Number
After entering the United States in TN status, the Occupational Therapist can apply for a Social Security Number, commonly called an SSN.
An SSN is commonly needed for:
- Employer payroll
- Tax reporting
- Employee benefits
- Banking
- Credit applications
- Housing applications
- Utilities
Your spouse and children do not automatically qualify for Social Security Numbers simply because they hold TD status.
How Long Does the Entire Process Take?
The timeline varies, but applicants should plan for several stages:
- OTED education review: several months or longer
- NBCOT exam preparation and scheduling: several months
- State licensing: one to several months
- VisaScreen: several months after complete documents are received
- Job search and interviews: varies
- TN application: completed after the other requirements and job offer are ready
- SSN application: completed after entering the United States
For many Canadian Occupational Therapists, the complete process may take approximately 9 to 18 months. It may take longer if additional academic documents or coursework are required.
Starting early is not pessimistic. It is paperwork self-defence.
Common Mistakes Canadian Occupational Therapists Should Avoid
- Assuming a Canadian OT licence automatically transfers to the USA
- Confusing NBCOT certification with state licensure
- Applying for the NBCOT exam without completing OTED
- Choosing a state before reviewing its licensing requirements
- Waiting too long to request transcripts and course descriptions
- Starting VisaScreen too late
- Assuming every Canadian applicant receives an English-test exemption
- Applying for TN status without the final VisaScreen Certificate
- Using an employer letter that does not clearly describe an Occupational Therapist position
- Assuming a spouse can work in TD status
Can Canadian Occupational Therapy Assistants Obtain a TN Visa?
Occupational Therapy Assistants do not qualify under the Occupational Therapist TN professional category.
The TN category applies to qualified Occupational Therapists, not Occupational Therapy Assistants.
An assistant would need to qualify independently under another U.S. immigration category, if one is available.
How IntelliStaff Medical Can Help
The process of becoming eligible to work in the United States involves several organizations, each with its own forms, terminology, fees, and document requirements.
IntelliStaff Medical can help Canadian Occupational Therapists:
- Understand the general order of the steps
- Identify U.S. Occupational Therapy opportunities
- Connect with facilities hiring qualified Canadian OTs
- Prepare for employer interviews
- Coordinate job-offer requirements
- Understand the TN visa employment process
- Plan for relocation and border entry
IntelliStaff Medical is not the employer, licensing board, certification organization, or immigration authority. The hiring U.S. facility will employ the successful candidate.
Final Thoughts
Canadian Occupational Therapists can work in the United States under TN status, but the process begins well before the border.
Most applicants will need to:
- Confirm TN and state eligibility
- Complete the NBCOT OTED review
- Pass the NBCOT examination
- Obtain state licensure
- Complete VisaScreen through TruMerit
- Secure a qualifying job offer
- Apply for TN status
- Enter the United States and obtain an SSN
The process requires planning, patience, and an impressive relationship with your document scanner.
IntelliStaff Medical can help you understand the steps and connect with U.S. healthcare facilities looking for qualified Occupational Therapists.
With the right roadmap, moving from Canada to a U.S. Occupational Therapy position becomes a manageable project rather than a paperwork mystery.
