If you are a COTA wondering whether entrepreneurship is even an option for you, the short answer is yes. The longer answer involves understanding what you can and cannot do under your credential, identifying the business models that work within your scope, and finding the right OTR partnerships to unlock clinical revenue streams.
OT Connected is built for all OTPs — OTRs and COTAs alike. Here is your roadmap.
The Legal Reality
COTAs can own and operate businesses just like anyone else can. A COTA can form an LLC, get an EIN, open a business bank account, and build a company. What a COTA cannot do is practice occupational therapy independently without OTR supervision. This is a scope-of-practice distinction, not a business ownership restriction.
The specifics vary by state. Some states require direct supervision for all COTA-delivered OT services. Others allow general supervision, meaning the OTR does not need to be physically present for every session. You must know your state practice act inside and out before building your business model.
Business Models That Work for COTAs
The key is identifying services and business models that either fall outside the OT scope of practice (and therefore do not require OTR supervision) or that build in an OTR supervision relationship from the start.
1. Models That Do Not Require OTR Supervision
- Wellness and prevention programs: Fitness classes, community wellness workshops, stress management programs, and ergonomic consulting that are marketed as wellness rather than OT treatment
- Caregiver training and coaching: Non-clinical education for family caregivers on safe transfers, home safety, and daily routine management
- Adaptive equipment consulting: Helping clients select and set up adaptive equipment, home safety products, and assistive technology without providing clinical OT treatment
- Digital product creation: Developing and selling educational resources, handouts, training materials, and online courses
- Community workshops: Teaching fall prevention classes, home safety seminars, and health education programs at senior centers and community organizations
2. Models That Require an OTR Partnership
- Clinical OT services: Evaluation and treatment require OTR involvement. You can build a practice that employs or contracts with an OTR who provides supervision and performs evaluations while you deliver treatment
- Mobile outpatient OT services: A COTA-owned practice can provide OT in the home with an OTR performing evaluations and supervising treatment per state and payer requirements
- Specialized clinical programs: Fall prevention interventions, cognitive rehab programs, and other clinical services with an OTR on the team
The 2025 Medicare Change
A significant policy update benefits COTAs in private practice. CMS changed the supervision requirement for occupational therapy assistants in private practice under Medicare Part B from direct supervision to general supervision. This means the supervising OTR no longer needs to be in the same building during every treatment session.
This change opens the door for COTAs to deliver Medicare-billable services in private practice settings with an OTR available by phone or teleconference rather than physically present. It substantially reduces the logistical barriers to building an OTR-COTA practice model.
Finding an OTR Partner or Supervisor
For clinical business models, your OTR relationship is critical. You need an OTR who is willing to provide supervision, perform evaluations, and share in the clinical governance of the practice.
Options include hiring an OTR as a part-time employee, contracting with an OTR for supervision and evaluations, partnering with an OTR as a co-owner, or engaging a per diem OTR who performs evaluations as needed.
The arrangement should be formalized in a written agreement that specifies supervision frequency, evaluation responsibilities, documentation standards, and compensation. Don’t build a clinical practice on a handshake supervision arrangement.
What to Look for in an OTR Partner
- Licensed and in good standing in your state
- Experienced in your niche population
- Willing to commit to a consistent supervision schedule
- Aligned with your practice philosophy and business goals
- Comfortable with the business structure and compensation model
Certifications That Expand Your Opportunities
Additional certifications can broaden your service offerings and strengthen your professional positioning, whether or not they involve clinical OT practice.
Consider certifications in areas like aging-in-place consulting (CAPS from NAHB), dementia care (CDP), lymphedema management, assistive technology, or hand therapy. Each of these opens new revenue streams and deepens your expertise.
The OT Connected knowledge base has a full article on certifications for COTAs that maps credentials to business opportunities.
Your Next Step
COTAs bring enormous clinical value to the OT profession, and that value translates directly into business opportunities when paired with the right model and the right partnerships. The entrepreneurship path is open to you — it just requires a clear understanding of scope and a strategic approach to business structure.
OT Connected supports both OTRs and COTAs on their entrepreneurship journey. The knowledge base, tools, and community are here for every OTP.
Join OT Connected and start building your business as a COTA.