Short answer? YES—you can start a business as a COTA! 🎉
Longer answer? It depends on what kind of business you want to start, and how it aligns with state laws, licensure rules, and your role as an assistant under OT supervision.
Let’s walk through the key things to know so you can make an informed, empowered decision!
COTAs Can Start a Business—But with Boundaries
While COTAs can’t legally practice OT independently, they can own or co-own businesses that offer OT services, supportive services, or wellness-based services. The trick is making sure you're staying in your lane legally and ethically.
Here's what COTAs can’t do:
- Treat clients independently under OT licensure
- Open a clinic that provides OT services without having an OTR on board
Business Ideas That Are in Bounds for COTAs
COTAs can start or run businesses in several areas—some that include OT (with proper structure) and others that don’t require licensure at all:
1. Co-Own or Operate an OT Practice (with an OTR partner)
- As long as an OTR is involved in evaluation and supervision, this is fair game.
- You can focus on operations, client care (under supervision), and scaling the practice.
2. Private Pay or Wellness Services (non-OT)
- With the right certification and scope, you can offer:
3. Consulting or Educational Businesses
- Examples:
Key Decision-Making Questions for COTAs
Before you dive in, here are a few must-consider points:
What does your state practice act say?
- Every state has slightly different rules around COTA supervision, billing, and business structure.
- Some allow more flexibility for non-clinical services; others are stricter.
- Dig in to your specific state practice act in Why should I know the rules for my state?
Do you have an OTR partner?
- If you plan to offer OT services, you’ll need an OTR for evaluations, documentation oversight, and general supervision.
- Your name can be on the LLC, but your practice must operate within OT supervision laws.
Are you billing insurance or private pay?
- Insurance = licensed OT supervision required
- Private pay wellness/education = more flexibility, but you must clearly communicate that it’s not “occupational therapy”
Are you covered legally?
- Even if you’re not doing clinical OT, you still need:
Bottom Line: COTAs Can Be Amazing Business Owners!
You bring so much value as a COTA—your clinical knowledge, creativity, and empathy make you perfect for entrepreneurship. Just make sure you're:
- Clear about what services you’re offering
- Compliant with state laws and supervision rules
- Partnering with an OTR if you plan to deliver OT care
Want to Explore Business Ideas That Fit Your Credentials?
Sarah Lyon, OTR/L, wrote a great article specifically for COTAs exploring their career options and advancement paths 👉 Where to Go With a COTA Degree
It’s a fantastic starting point if you’re dreaming big and want to align your next step with your passion and licensure.