Initial Application - Personal Information

License Information

I am applying for

Occupational Therapist

Occupational Therapy Assistant

Application Type

Standard

Temporary

Provisional

Applicant Information

Please complete the information below. Your name should be entered how it is to appear on your license.


First Name	Middle Name	Last Name	Suffix
Other Names you have used	Social Security Number / Taxpayer Identification Number	Gender
Date of Birth	Place of Birth


US Citizen	Yes	No


Authorized to Work in the USA	Yes	No

Page Updated: 10/13/2022 11:38:21 AM

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Contact Us

NV Board of Occupational Therapy
6170 Mae Anne Avenue, Suite 1
Reno, NV 89523
Phone: 775-746-4101
Fax: 775-746-4105
Email: Contact Form | board@nvot.org

Hours: 9:00 AM - 4:00 PM, Monday - Friday

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