Visa and Work Authorization Options for Foreign-Trained Physical and Occupational Therapists

Clear your credential check first

Before any US work visa case moves forward, a foreign-trained physical or occupational therapist needs a Health Care Worker Certification, sometimes called a VisaScreen. This confirms your education, license, and English proficiency meet US standards for your profession.

• Physical therapists apply through the Foreign Credentialing Commission on Physical Therapy (FCCPT) , which reviews your transcripts and clinical training and issues a Type I certificate once you qualify.

• Occupational therapists apply through the National Board for Certification in Occupational Therapy (NBCOT) , which issues a Visa Credential Verification Certificate (VCVC), or through CGFNS.

Either route often takes several months, so start early, well before your employer expects to file your visa petition. You also need to pass your national exam, the NPTE for physical therapists or the NBCOT certification exam for occupational therapists, and get licensed in the state where you plan to work, since state licensure rules do not automatically transfer between states.

H-1B: the standard route

Most US employers sponsor foreign-trained PTs and OTs through the H-1B specialty occupation visa once your credential certificate and state license are in place. Your employer files a Labor Condition Application with the Department of Labor, then submits your H-1B petition.

H-1B visas run on an annual numerical cap with a spring lottery, so timing matters. If your employer misses the registration window or you are not selected, you wait for the next cycle unless another visa category applies to you.

As of August 2026, a separate issue affects some H-1B cases: a September 2025 proclamation tried to add a fee of $100,000 on certain new H-1B petitions filed for workers abroad who need consular processing. A federal court struck that fee down, and the First Circuit Court of Appeals refused to reinstate it on July 24, 2026, so it is not currently enforced, though the government's appeal continues and a new $103,265 version was proposed on August 24, 2026. Confirm the current rule on the USCIS H-1B FAQ page before your employer files, since this sits in active litigation and the rule shifts without notice.

TN visa for Canadian and Mexican citizens

If you hold Canadian or Mexican citizenship, the TN visa skips the H-1B lottery. Physiotherapist/physical therapist and occupational therapist both appear on the USMCA list of qualifying professions, according to university international office guidance on TN status. You still need your Health Care Worker Certification and state license first, then your employer offers you a role and you apply for TN status at a port of entry or US consulate rather than waiting for an annual lottery window.

Hospitals and university-affiliated health systems offer another advantage here. Employers that are universities or nonprofit organizations affiliated with a university are generally exempt from the H-1B annual numerical cap, so a PT or OT role at a teaching hospital or university clinic bypasses the lottery entirely. Ask a prospective employer directly whether they qualify as cap-exempt, since a cap-exempt job offer removes the biggest source of H-1B timing risk from your case.

The green card gap between PT and OT

For a green card, physical therapists have an advantage occupational therapists do not. Registered nurses and physical therapists sit on the Department of Labor's Schedule A list, which lets an employer skip standard PERM labor market testing and file the immigrant petition directly, according to USCIS policy guidance .

Occupational therapists are not on that list, so an OT's employer runs a full PERM labor certification process, testing the local job market before filing the immigrant petition.

This does not block an OT from getting a green card. It adds a step and time that a PT sponsored under the same category does not have to go through. Plan for that extra step if you are an OT weighing a permanent move, and ask a prospective employer early whether they have sponsored PERM cases before, since experience with the process on their side keeps your case moving.

PT vs OT: quick comparison

Your state license is separate from your visa

A work visa authorizes you to work in the US, it does not license you to practice as a PT or OT. Each state licensing board runs its own process on top of your national exam and Health Care Worker Certification, often including a jurisprudence exam covering that state's specific practice rules and a criminal background check.

Licenses do not automatically transfer between states, so a move for a new job later in your career usually means applying for a new state license again, on top of any visa transfer your new employer handles. Build both timelines into your planning before you accept a job offer in a state where you are not yet licensed.