Occupational therapists can work with patients who experience a wide range of injuries, medical conditions, and functional limitations. However, some of these professionals choose to narrow their practice to a particular area and develop specialized expertise in treating conditions that affect the hands and upper extremities.
Hand therapy is an advanced area of rehabilitation that can be practiced by both OTs and PTs. Professionals who want to formally demonstrate their expertise in this field can pursue the Certified Hand Therapist credential, which requires several years of professional practice, extensive direct experience in hand therapy, and a specialized certification examination.
In the article below, we’ll show you how to become a certified hand therapist and walk you through the entire qualification process in a step-by-step manner.
Understanding the Certified Hand Therapist Professional Role
Certified hand therapists are rehabilitation professionals who specialize in evaluating and treating conditions that affect the hands and upper extremities. Despite the name of the specialty, their practice is not limited to the hands alone and can extend to the wrist, forearm, elbow, and shoulder girdle when these areas affect upper-limb function.
When working with a new patient, the first step for a CHT is to assess the condition of the affected upper extremity and determine how it limits the patient’s movement and function. Then, based on their findings, they develop an individualized treatment plan and begin providing the appropriate rehabilitative care.
Considering the complexity of hand and upper-extremity rehabilitation, certified hand therapists may work with a wide variety of conditions, including fractures, tendon and ligament injuries, nerve damage, burns, amputations, arthritis, and postoperative complications.
The techniques that CHTs might use to treat their clients, naturally, depend on the patient’s condition as well as the specific functional limitations they are experiencing. Some of the most common interventions include therapeutic exercise, manual therapy, custom orthoses, wound and scar management, edema control, sensory re-education, and adaptive techniques.
We should point out that in more complex cases, such as traumatic injuries or postoperative rehabilitation, CHTs may also collaborate with other healthcare professionals such as hand surgeons and physicians to coordinate treatment and support the patient’s recovery.
One thing that is important to understand about the hand therapist role is that it is not a standalone healthcare discipline, but rather a specialized area of rehabilitation practice.
This means that professionals trained in providing both physical therapy and occupational therapy can move into this field if they develop the necessary clinical experience and meet the requirements for hand therapy certification.
OT and PT Pathways to Hand Therapy
As we just mentioned, both occupational therapists and physical therapists can specialize in hand therapy and pursue CHT certification. However, the way that each of these groups of professionals approaches rehabilitation is not exactly the same.
Namely, the education for becoming a physical therapist generally places greater emphasis on restoring movement, strength, mobility, and physical function, which can make their work in hand therapy particularly focused on improving the mechanical and functional use of the affected upper extremity.
On the other hand, OT education places greater emphasis on helping patients perform everyday activities and participate more independently in daily life, which makes the OT approach to hand therapy particularly focused on restoring the functional use of the upper extremity during work, self-care, and other meaningful activities.
And even though both qualification pathways are equally viable, in the guide below, we will keep our focus on becoming a certified hand therapist through the OT route, as the vast majority of CHTs enter the specialty through occupational therapy.
Key Qualifications for Becoming a Certified Hand Therapist
Having established the professional pathways that can lead to hand therapy, we can now take a closer look at the specific qualifications candidates need to meet before they can earn the CHT credential.
To become eligible for practicing as a CHT in a professional capacity, the Hand Therapy Certification Commission requires candidates to meet the following criteria:
- Complete a four-year bachelor’s degree in a suitable field of study
- Earn a graduate degree in occupational therapy from an ACOTE-accredited program
- Complete the required supervised fieldwork
- Pass the NBCOT certification examination
- Obtain a state-issued occupational therapy license
- Hold their professional OT credential for at least three years
- Accumulate at least 4,000 hours of Direct Practice Experience in hand therapy
- Pass the Hand Therapy Certification Examination and earn the CHT credential
In other words, aspiring CHTs first need to go through the entire qualification process for becoming a licensed occupational therapist before they can move on to the specialized requirements for hand therapy certification.
How to Become a Certified Hand Therapist: Step by Step
Having outlined the main qualifications required to become a CHT, we can now move on to the practical part of the guide and walk you through each step of the qualification pathway.
Complete Your Undergraduate Education
The first step towards becoming a certified hand therapist through the occupational therapy route is enrolling in a bachelor’s degree program, which typically takes around four years of full-time study. Given that this is only the beginning of the qualification process, aspiring CHTs are not expected to pursue any specific undergraduate major to remain eligible for occupational therapy education.
Having said that, this doesn’t mean that undergraduate students can’t be strategic about their choice of major and select subjects that will support their later studies. Majors like biology, kinesiology, psychology, and health sciences can all prove to be useful and help students build a solid academic foundation that they can rely on during the more advanced stages of their education.
And while undergraduate education is quite flexible, aspiring CHTs still need to prepare for admission into the occupational therapy programs that form the next stage of the qualification process.
Unfortunately, every program establishes its own admission requirements, which means students need to review the prerequisites of the schools they are considering and make sure their undergraduate coursework satisfies them before they apply.
Earn an Accredited Occupational Therapy Degree
Once they earn their undergraduate degrees, aspiring CHTs can move on to the graduate-level education required to become occupational therapists. At this stage of their education, they can choose between the two entry-level degree pathways available for OT practice:
- Master’s Degree in Occupational Therapy, which provides the academic and clinical preparation students need to enter general occupational therapy practice and may lead to credentials such as a Master of Occupational Therapy (MOT), Master of Science (MS), or Master of Arts (MA).
- Doctor of Occupational Therapy degree, which provides the same preparation for professional OT practice while also incorporating additional education in areas such as research, leadership, administration, advocacy, and program development, along with a doctoral capstone experience.
The graduate phase of occupational therapy education represents one of the most important components of the professional preparation required for this job, during which students develop the theoretical knowledge and clinical reasoning skills required for practice.
So, regardless of whether they decide to pursue a master’s degree or an OTD, aspiring hand therapists can eventually qualify for the CHT credential, as neither degree pathway is specifically required for hand therapy certification.
And while the choice between these two degrees is not that important, the key consideration at this stage of their education is accreditation. To make sure that their degree qualifies them for the next stage of the OT certification process, students need to enroll in an entry-level occupational therapy program accredited by ACOTE.
Satisfy Your Supervised Fieldwork Requirement
In addition to completing the academic portion of their occupational therapy degree, OT students must also participate in supervised fieldwork experiences built into their program.
These experiences allow them to apply the knowledge and clinical reasoning developed in the classroom while gradually becoming more familiar with the responsibilities involved in providing occupational therapy services.
In most ACOTE-accredited programs, the fieldwork component is split into two levels:
- Level I Fieldwork, which introduces students to occupational therapy practice and allows them to observe and participate in selected aspects of service delivery under supervision
- Level II Fieldwork, which provides more intensive clinical experience and requires students to take on progressively greater responsibility for evaluating clients, planning interventions, and providing occupational therapy services
By the end of their fieldwork education, OT students should be more confident applying their academic knowledge in clinical settings and better prepared to take on the responsibilities expected of entry-level occupational therapists.
Pass the NBCOT Certification Examination
With both the academic and fieldwork components of their occupational therapy education complete, graduates can move on to the certification phase of the qualification process and take the Occupational Therapist Registered (OTR) examination administered by the National Board for Certification in Occupational Therapy (NBCOT).
This exam is designed to assess whether candidates have developed the knowledge and clinical reasoning required to provide occupational therapy services at an entry-level professional standard. Candidates complete the examination electronically and answer questions covering areas such as evaluation, treatment planning, intervention, and professional practice.
Those who achieve a passing score earn the OTR credential and become nationally certified occupational therapists. However, earning this certification does not yet give them the legal authority to practice independently, as occupational therapy licensure is regulated separately at the state level.
Secure Your Occupational Therapy License
After earning the OTR credential, candidates can move on to the final stage of becoming fully qualified occupational therapists and apply for a license in the state where they intend to practice.
To secure this authorization, they must satisfy the requirements established by the occupational therapy licensing authority in their jurisdiction. While the exact process can vary by state, applicants may need to submit proof of their education and NBCOT certification, complete a background check, pass a jurisprudence examination, and pay the required licensing fee.
Once the application is complete, the appropriate state board will review the submitted documentation and determine whether the candidate meets all of the licensing requirements. If everything is in order, the applicant will receive their professional OT license and be granted authorization to practice occupational therapy in that jurisdiction.
Gain More Experience Treating Hand Conditions
The moment candidates receive their occupational therapy license, they become legally qualified to begin practicing as professional OTs. This means that they can start working at a professional capacity and treat patients with all kinds of functional limitations.
However, OTs interested in becoming certified hand therapists should use the early stage of their careers to begin developing experience in hand and upper-extremity rehabilitation. This will not only help them become more proficient in this area of practice, but also allow them to work toward the experience requirements for CHT certification.
Namely, the Hand Therapy Certification Commission imposes an eligibility requirement that involves accumulating at least 4,000 hours of Direct Practice Experience in hand therapy before candidates can sit for the certification examination. What’s more, therapists must have held their professional OT credential for at least three years by the time they apply for the exam.
So, the best course of action for aspiring CHTs is to begin accumulating relevant clinical experience as early as possible. The best way to make sure they get the necessary exposure is to look for employment opportunities where they can regularly evaluate and treat patients with conditions affecting the hands and upper extremities, such as outpatient rehabilitation clinics, orthopedic practices, and hospitals.
Apply for a CHT Certification
Once aspiring CHTs accumulate the required hand therapy experience and satisfy the three-year professional practice requirement, they can formally begin the certification process by submitting an application to the Hand Therapy Certification Commission.
To demonstrate their eligibility for the exam, applicants need to provide documentation that confirms that they meet the requirements established by HTCC. This includes proof of their current professional credential, evidence that they have held it for at least three years, and verification of their 4,000 hours of Direct Practice Experience in hand therapy.
One important detail that we need to point out here is that the Hand Therapy Certification Examination is only offered twice yearly during designated spring and fall testing periods. This means that candidates need to submit their application and supporting documentation within the corresponding application window.
Once the Commission reviews the submitted materials and confirms that all eligibility requirements have been met, candidates can move on to the certification examination.
Pass the Hand Therapy Certification Exam
After HTCC approves their application, candidates can move on to the final stage of the certification process and take the Hand Therapy Certification Examination. The exam gives candidates four hours to answer 200 multiple-choice questions that will determine whether they possess the knowledge and clinical judgment required for professional hand therapy practice.
More specifically, the examination evaluates candidates across areas such as upper-limb assessment, prognosis and treatment planning, therapeutic interventions, and the fundamental knowledge and basic sciences that support hand therapy practice.
To pass the examination, candidates need to achieve a score of at least 75 points. Those who meet this standard earn the Certified Hand Therapist credential and can begin using the CHT designation professionally.
Start Practicing as a Certified Hand Therapist
Once candidates pass the Hand Therapy Certification Examination, they officially earn the CHT credential and can begin identifying themselves professionally as certified hand therapists.
In other words, they can continue practicing under their existing occupational therapy license while using their advanced certification to demonstrate specialized expertise in hand and upper-extremity rehabilitation.
Depending on their experience and employment setting, CHTs may work in outpatient rehabilitation clinics, orthopedic practices, hospitals, surgical centers, and other facilities where patients receive treatment for complex upper-extremity conditions.
Their certification can also help them take on more specialized caseloads involving postoperative rehabilitation, traumatic injuries, nerve conditions, tendon repairs, and other cases that require advanced hand therapy knowledge.
Job Outlook and Salary for Certified Hand Therapists
Having explored the entire qualification process for becoming a certified hand therapist, we thought it’d be a good idea to also take a look at the earning potential and employment outlook associated with this specialty.
When it comes to earnings, the available salary estimates vary considerably between sources. ZipRecruiter currently places the average annual salary for certified hand therapists at $94,297, with most professionals earning between $83,500 and $106,000. On the other hand, Salary.com reports a considerably higher national average of $116,428.
Naturally, the actual salaries can also differ depending on where a CHT works. For example, Salary.com estimates an average annual salary of $119,992 for certified hand therapists in Maryland, compared with $106,858 in Alabama.
What’s more, individual job opportunities can vary even more, with current listings showing compensation ranging from around $83,000 to $110,000 per year for one full-time position in Washington and $43.09 to $66.47 per hour for a PRN position in Colorado.
The available workforce data also points to continued growth in the specialty. ASHT reported 6,949 certified hand therapists in the United States in its 2024 annual report, while the 2025 report placed that number at 7,331, representing an increase of about 5.5%.
Current hiring activity provides another indication that CHTs remain in demand. Glassdoor’s indexed results showed around 1,970 certified hand therapist openings across the United States, while ZipRecruiter continues to list positions in cities such as Dallas, Seattle, Denver, Atlanta, Sacramento, and Pittsburgh.
While these figures do not amount to a formal long-term employment projection, they suggest that the number of certified professionals is growing alongside continued hiring activity across different parts of the country. (ASHT, ASHT, Glassdoor, Salary.com, Salary.com, Salary.com, ZipRecruiter, ZipRecruiter)
Closing Words
Injuries and conditions affecting the hands and upper extremities can significantly limit a person’s ability to work, complete everyday activities, and function independently. Certified hand therapists can help patients manage these challenges through specialized rehabilitation designed to restore movement, improve function, and support recovery.
Becoming a certified hand therapist is a multi-stage process that requires first qualifying and gaining professional experience as an occupational therapist before developing extensive expertise in hand therapy and earning the CHT credential.
For occupational therapists interested in working with complex upper-extremity conditions and developing a highly specialized area of practice, pursuing hand therapy certification can be a rewarding way to advance their careers.
FAQs
How long does it take to become a certified hand therapist?
Becoming a certified hand therapist can take around nine to ten years from the beginning of undergraduate education. This timeframe generally includes four years for a bachelor’s degree, another two to three years for graduate occupational therapy education, and at least three years of professional OT practice before candidates become eligible for CHT certification.
During those three years of professional practice, therapists can also accumulate the 4,000 hours of Direct Practice Experience in hand therapy required by HTCC, so these two experience requirements do not need to be completed separately.
What degree do you need to become a Certified Hand Therapist?
There is no separate degree specifically for becoming a certified hand therapist. Individuals interested in entering this field professionally need to first qualify as either occupational therapists or physical therapists and then satisfy the additional clinical experience and certification requirements established by HTCC.
For those following the occupational therapy route, this means earning either a master’s degree or professional doctorate in occupational therapy from an accredited entry-level program before moving on to certification and state licensure.
Do you need CHT certification to work in hand therapy?
No, occupational therapists and physical therapists can gain experience treating hand and upper-extremity conditions without already holding the CHT credential. In fact, therapists need this type of professional experience before they can become eligible for certification.
HTCC requires candidates to accumulate at least 4,000 hours of Direct Practice Experience in hand therapy and to have held their professional OT or PT credential for at least three years before they can sit for the certification examination.
Can a physical therapist become a Certified Hand Therapist?
Yes, physical therapists can become certified hand therapists as long as they satisfy the eligibility requirements established by HTCC.
Like occupational therapists, PTs must hold an active professional credential, have at least three years of professional experience, accumulate 4,000 hours of Direct Practice Experience in hand therapy, and pass the Hand Therapy Certification Examination.
Although both professional pathways are equally valid, occupational therapy is considerably more common among CHTs.