Hi. If the state you work in requires licensure, then you must be licensed (not all states require licensure, I believe). You must pass the initial certification exam given by the NBCOT, however, you are not required to continue to register with the NBCOT. In Ohio, I must be licensed to practice but I no longer use the R because I didn't register again with the NBCOT. The Ohio licensure board has requirements for continuing education that I follow. Now I am OT/L.
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