NBCOT COTA Exam 2026: 190 Questions, 4 Hours, 450 to Pass

Who takes the COTA exam?

You need an entry-level degree from an OTA program accredited by the Accreditation Council for Occupational Therapy Education (ACOTE); ACOTE accredits OTA programs at the associate and baccalaureate levels.

A COTA works with an OTR. NBCOT describes the OTR as the one who evaluates the client, plans the interventions and supervises the COTA, and the COTA as the one who carries out and documents the interventions and reports the client’s progress back.

How is the NBCOT COTA exam different from the OTR?

	COTA exam	OTR exam
Items	190	180
Multi-select items	Six options, on their own	Six options, in scenario sets of four
Domains	3	4
Biggest domain	Implementing interventions, 55%	Managing interventions, 38%
Exam time	4 hours	4 hours
To pass	Scaled 450	Scaled 450

The COTA outline frames gathering information and carrying out interventions as work done under the OTR’s supervision. The full domain table is on the study guide page.

OTR and COTA content outlines →NBCOT passing score →

COTA study tools from NBCOT

NBCOT sells COTA versions of its tools: three COTA practice tests, a COTA StudyPack, COTA flashcards and Knowledge Match, and COTA Practice Sims with four virtual clients. Its free Entry-Level Self-Assessment for COTA is meant for students in associate or bachelor’s OTA programs.

COTA practice tests from NBCOT →COTA pass rates →

Going from COTA to OTR

If you pass the COTA exam and later earn an occupational therapy degree, you apply for the OTR exam from the same MyNBCOT account: add the occupational therapy degree to your profile from the Student Dashboard first. If you hold both, both stay Active in Good Standing: under NBCOT’s Dual Certification Policy your COTA expiration date moves to match your OTR one, and both renew or expire together.

NBCOT Dual Certification Policy (PDF) ↗

Sources: NBCOT · ACOTE and 5 more. Checked October 2026.