Occupational Therapy Assistant Career Assessment
Rehabilitation specialist
1Welcome
Occupational therapy assistants work with occupational therapists to help people recover abilities and independence in daily activities after injury, illness, or disability.
You'll explore what this people-focused, purposeful career is really like, and whether it fits your values and skills.
This takes about 15 minutes.
2What is an Occupational Therapy Assistant?
An occupational therapy assistant (OTA) works under the supervision of an occupational therapist, helping clients regain skills and independence in daily activities — eating, bathing, dressing, working, playing.
The Reality: You're not the therapist (OT does evaluations and planning). You implement the therapy. You're the hands-on coach and encourager.
Your Responsibilities:
- Help clients perform therapeutic activities
- Adapt activities to match client abilities
- Provide encouragement and emotional support
- Document progress and observations
- Teach clients strategies for independence
- Assist with fine and gross motor activities
- Help with cognitive and behavioral activities
- Maintain equipment and therapy space
- Communicate with clients, families, and care team
- Follow therapist-designed treatment plans
You're part coach, part teacher, part advocate.
3A Day in the Life
7:30 AM — Arrive at rehab facility. Review caseload for today. Read progress notes.
8:00 AM — First client: 72-year-old post-stroke. Limited mobility on left side. Work on dressing with adaptations. Celebrate small wins. Encourage independence.
8:45 AM — Second client: child with fine motor delays. Play-based therapy using activities that build finger strength. Make it fun.
9:30 AM — Document progress. Communicate with OT supervisor about concerns.
9:45 AM — Third client: adult with hand injury. Work on grip strength and coordination using adaptive equipment.
10:45 AM — Group therapy: Several clients in adaptive cooking class. Work on balance, safety, sequencing, decision-making all at once.
12:00 PM — Lunch
1:00 PM — More individual sessions. Different clients. Different goals. Same heart — helping people regain independence.
3:00 PM — Team meeting. Discuss progress with OT, social worker, nurse. Plan next steps.
3:30 PM — Equipment maintenance. Space setup for tomorrow.
4:00 PM — Document and wrap up.
Purposeful, people-focused, rewarding work.
4Training in North Dakota
COTA (Certified Occupational Therapy Assistant) Required. ND licensing and COTA certification are necessary to work.
Training Pathways:
- OTA Program (2 years): Associate degree (AAS). Classroom + lab + fieldwork. Must be ACOTE-accredited. Cost varies by school.
- Online + Clinical (2 years): Some programs offer hybrid models with online classes and hands-on clinicals locally.
In North Dakota: North Dakota State College of Science (NDSCS) in Wahpeton has the only OTA program in the state. It is an AAS degree, about 2 years (4 semesters), and ACOTE-accredited. Some classes are online. Fieldwork at rehabilitation centers, hospitals, schools, mental health facilities.
Prerequisites: High school diploma/GED. Basic science helpful. Strong people skills essential.
Clinical Hours: At least 16 weeks of full-time supervised fieldwork (Level II) in actual OT settings. Real clients. Real responsibility.
5Certification & Licensing
COTA (Certified Occupational Therapy Assistant). National exam from NBCOT. All states require passing it to get licensed.
North Dakota Requirements:
- Complete ACOTE-accredited OTA program (2 years)
- Pass NBCOT (National Board for Certification in Occupational Therapy) exam
- Apply for an ND OTA license from the ND State Board of Occupational Therapy Practice
The Exam: NBCOT COTA exam. 190 questions. 4 hours. Covers OT theory, practice, ethics, clinical skills, adaptations, documentation.
Cost: $540 (NBCOT online application)
Pass Rate: 67% of new COTA graduates passed on the first try in 2025 (NBCOT). Ask any program you are considering for its pass rate.
Continuing Education: ND licenses renew every 2 years (even years, by June 1). You need 20 CE hours in each 2-year period. Keeps you current with new techniques.
Reciprocity: Your NBCOT certification is national, but each state has its own license. ND joined the OT Licensure Compact in 2025, but as of 2026 it is not issuing compact privileges yet. Check with the ND board for updates.
6Salary & Job Outlook
North Dakota Occupational Therapy Assistant Salary (BLS, May 2025):
- Lower-paid workers (bottom 10%): about $23.44/hour ($48,760/year)
- Median (middle): $29.31/hour ($60,970/year)
- Top-paid workers (top 10%): about $31.51/hour ($65,540/year)
Specialty settings (hand therapy, pediatrics, geriatrics, mental health) may vary.
Benefits: Health insurance, retirement, paid time off, CE reimbursement.
Job Outlook: Excellent. BLS projects OTA jobs to grow 21% nationally from 2025 to 2035, much faster than average. An aging population drives demand.
Work Environment: Rehabilitation centers, hospitals, schools, community health, mental health facilities, homes. Mostly Monday-Friday. Some weekends/evenings.
Physical Demands: Moderate. Standing, lifting, repetitive motions. You help move and support clients safely.
Pay by Area in North Dakota (middle/median yearly pay, BLS May 2025)
| North Dakota (statewide) | $60,970 |
| Fargo area (incl. Moorhead, MN) | $63,660 |
| Rural eastern ND | $52,480 |
Areas not listed had too few workers in this job for BLS to report pay.
7Where This Leads
Path 1: Specialize — Hand therapy, pediatrics, geriatrics, mental health, aquatic therapy. Build expertise. Higher pay.
Path 2: Management — Oversee OTA/OT team. Run a rehab department. Budgets and schedules.
Path 3: Education — Teach OTA program. Develop curriculum. Mentor students.
Path 4: Occupational Therapist (OT) — Return to school. Become an OT. You need about 3-4 years of college first (many programs want a bachelor's degree). Then a master's or doctorate in OT takes about 2-3 more years. In ND: UND in Grand Forks (doctorate) and University of Mary in Bismarck and Fargo (master's or doctorate). Your OTA experience helps.
Path 5: School System — Work in schools helping children with disabilities. Different pace. Different population.
Path 6: Community/Home Health — Visit clients at home. Independence-focused work. Less structured, more autonomous.
Path 7: Program Development — Create new therapy programs. Innovate new approaches.
8The Real Talk
What's Great:
- Deeply meaningful work (help people regain independence)
- Regular patient contact and relationships
- Variety (different clients, different needs)
- Creativity in adapting activities
- Team environment (work with OTs, nurses, therapists)
- Good pay for education level
- Job security and growth
- Clear advancement paths
What's Hard:
- Emotional labor (seeing people struggle, frustration)
- Physical demands (standing, lifting, moving)
- Burnout from seeing limited progress in some cases
- Dealing with pain and disability daily
- Family members can be demanding or unsupportive
- Documentation and paperwork heavy
- Reimbursement/insurance frustrations
- Limited autonomy (work under OT supervisor)
Be Honest: Do you find meaning in helping others? Can you celebrate small progress? Can you handle people's frustration and pain? Do you want direct patient care daily?
9Part 1: What Attracts You?
What draws you to occupational therapy?
10Part 2: Are You Ready?
1. I find deep meaning in helping others regain independence.
2. I can stay positive when clients struggle or progress slowly.
3. I'm comfortable with repetitive motions and moderate physical activity.
4. I'm creative and flexible in adapting activities.
5. I can work effectively under an OT supervisor (not independently).
6. I'm willing to pursue COTA certification and continuing education.
7. I have strong communication and interpersonal skills.
8. I can handle documentation and paperwork requirements.
11Part 3: Your Next Move
What's your plan?
Any other thoughts?