South Carolina Occupational Therapy License Requirements

To work as an occupational therapist or occupational therapy assistant in South Carolina, you need a license from the South Carolina Board of Occupational Therapy, which sits under the Department of Labor, Licensing and Regulation (LLR). The South Carolina occupational therapy license requirements include graduating from an ACOTE-accredited program, completing supervised fieldwork, passing both the NBCOT certification exam and a state jurisprudence exam, clearing a fingerprint-based FBI background check, and paying the application fee.¹ Once you’re licensed, you renew every two years and complete 16 hours of continuing education.

Education and Fieldwork

Occupational therapist applicants must graduate from a program accredited by the Accreditation Council for Occupational Therapy Education (ACOTE) or an equivalent body endorsed by the American Occupational Therapy Association. The statute requires at least six months of supervised fieldwork completed at or approved by the school that granted the degree.²

Occupational therapy assistant applicants must graduate from an ACOTE-accredited OTA program and complete at least two months of supervised fieldwork.² These state minimums line up with ACOTE’s accreditation standards of 24 weeks for OT students and 16 weeks for OTA students.³

Exams You Have to Pass

South Carolina requires two separate exams before issuing an initial license: the national NBCOT certification exam and a state jurisprudence exam.⁴

NBCOT Certification Exam

The OTR exam has 180 items that mix single-response multiple choice with multi-select scenario sets. You need a scaled score of at least 450 on a 300–600 scale to pass.⁵ The initial online exam application costs $540, and a retake costs $430.⁶

You register through NBCOT, receive an Authorization to Test letter, then schedule at a Prometric center. If you fail, you can’t retake the exam in the same calendar month. After three consecutive failed attempts, you have to wait six months from your last exam date before reapplying.⁷

South Carolina Jurisprudence Exam

Every initial applicant also has to pass a state jurisprudence exam covering South Carolina’s occupational therapy laws and regulations.⁴ The board administers it, and it’s separate from the NBCOT certification.

Applying to the Board

Applications go through the LLR. The initial application fee is $135 for occupational therapists and $115 for occupational therapy assistants.⁸ Along with the application, you submit:

Official transcripts or documentation confirming graduation from an accredited program.
Proof that your required supervised fieldwork was completed.
A national FBI criminal records check supported by fingerprints. SLED keeps the fingerprints on file and notifies the board of any future criminal charges.²

A criminal record isn’t an automatic disqualifier. The board looks at convictions case by case, weighing the nature and age of the offense against patient safety.

One thing to plan around: the board discontinued temporary licenses for new graduates in 2003.⁹ You cannot treat patients while waiting for exam results or for a full license to come through. Finish the NBCOT exam and the jurisprudence exam before you expect to start work.

Renewal and Continuing Education

Licenses expire on March 15 every other year. Renewing on time is your responsibility whether or not a reminder notice shows up.¹⁰ Biennial renewal fees are $100 for occupational therapists and $80 for occupational therapy assistants. A late renewal filed between March 16 and April 15 adds a $50 penalty.¹¹

Each renewal cycle requires 16 hours of continuing education.¹⁰ Submit proof on a board-approved form at renewal, and keep your records for at least four years because the board runs random audits.¹² Falling short can bring fines or temporary suspension. If serious illness, military service, or similar circumstances get in the way, you can ask the board for an extension or waiver.

At renewal you also have to keep your NBCOT certification active and disclose any disciplinary actions or criminal convictions from the renewal period. Lying on a renewal application is itself grounds for discipline, and letting a license lapse past the late window pushes you into the reinstatement process below.

If You’re Already Licensed in Another State

You have two paths: the Occupational Therapy Licensure Compact or licensure by endorsement.

Occupational Therapy Licensure Compact

South Carolina enacted the Occupational Therapy Licensure Compact in 2022 and is one of more than 30 member states.¹³ Eligible OTs and OTAs can obtain a compact privilege to practice in other member states without going through each state’s full licensing process. You generally need an active, unrestricted home-state license, current NBCOT certification, and a clean disciplinary record. You cannot start practicing in another member state until the privilege is actually issued.¹⁴

Endorsement

If you prefer not to use the compact, or your license is in a non-compact state, you can apply for South Carolina licensure by endorsement. You need:

A current, active, unrestricted license in another state with requirements that were equivalent to South Carolina’s at the time of your original licensure.
Current NBCOT certification in good standing.
Verification of all permanent licenses held in other states.
A completed application with the required fee.¹⁵

Endorsement applicants also go through the FBI and SLED fingerprint background check.²

Reinstating a Lapsed License

If your South Carolina license has lapsed for three years or more, getting it back takes supervised clinical hours, extra continuing education, and fees that scale with how long you’ve been out.¹⁶ The board can issue a provisional license so you can complete the supervised practice while you work toward reactivation.

Lapsed 3–5 years: 250 hours of supervised clinical practice under a South Carolina-licensed OT, 16 hours of in-person board-approved CE in your intended practice area, plus reactivation fees.
Lapsed 5–10 years: 350 hours of supervised clinical practice, 36 hours of in-person board-approved CE, plus reactivation fees.
Lapsed 10+ years: 500 hours of supervised clinical practice, 50 hours of in-person board-approved CE, a board-approved examination, plus reactivation fees.¹⁶

You submit a plan of action on a board-approved form showing how you’ll finish everything within one calendar year. The provisional license only authorizes practice under on-site supervision by a licensed OT and can’t be renewed without appearing before the board. The reactivation fee for moving from lapsed to active is $300 on top of the standard renewal fee.

Supervision Rules for OTAs

Occupational therapy assistants can only practice under the supervision of a licensed occupational therapist, and the supervising OT carries ultimate responsibility for the services the assistant provides. The statute sets specific obligations:¹

The supervising OT must consult with the OTA on each client every seven treatments or 30 days, whichever comes first.
The supervising OT must be accessible to the OTA each working day.
OTAs may assist with evaluations by gathering data and administering structured tests, but cannot evaluate a client independently or begin treatment before the supervising OT completes the initial evaluation.
OTAs may only perform duties they’ve been specifically trained and qualified to handle.

The supervising OT also has to perform the initial evaluation and establish the treatment plan for every client, and re-evaluate any client whose therapy has been significantly interrupted before reassigning the case to an OTA.

Practicing Without a License

Practicing occupational therapy in South Carolina without a license is illegal.¹ The board investigates complaints and can impose penalties ranging from warnings and fines to suspension or permanent revocation. Common violations include unlicensed practice, falsifying application or renewal documents, and failing to meet CE requirements. Patient harm and fraud are treated most severely and can lead to permanent disqualification.

1
South Carolina Legislature. South Carolina Code Title 40 Chapter 36 – Occupational Therapists
2
South Carolina Legislature. South Carolina Code 40-36-230 – Applications for Licensure as Occupational Therapist or Assistant; License Requirements
3
Accreditation Council for Occupational Therapy Education. Standards FAQ
4
South Carolina Board of Occupational Therapy. South Carolina Board of Occupational Therapy – Exam
5
NBCOT. Foundations of the Certification Examinations
6
NBCOT. Fees
7
NBCOT. After Your Exam
8
Legal Information Institute. South Carolina Code of Regulations 10-26 – Board of Occupational Therapy
9
South Carolina Board of Occupational Therapy. Temporary License Discontinued
10
South Carolina Legislature. South Carolina Code 40-36-260 – Time Period for Licenses; Renewal; Continuing Education
11
South Carolina Board of Occupational Therapy. Fees
12
South Carolina Board of Occupational Therapy. Continuing Education
13
Council of State Governments. Occupational Therapy Licensure Compact
14
Occupational Therapy Compact. Occupational Therapy Compact – Home
15
Legal Information Institute. South Carolina Code of Regulations 94-06 – Licensure by Endorsement
16
South Carolina Legislature. Chapter 94 – Board of Occupational Therapy Regulations