Licensing Questions for Hand Therapists Moving States

Your state license is what lets you practice hand therapy; the CHT is a national certification that sits on top of it. In most states an OT licensed there can provide hand therapy within the practice act without a separate state credential. A handful of states add their own approvals for hand therapy itself or for the modalities hand therapists use, and those are what a moving hand therapist needs to find before the first client.

Is the CHT a license?

No. The Certified Hand Therapist credential comes from the Hand Therapy Certification Commission (HTCC), a private certifying body. HTCC's eligibility page (archived January 2025) requires that you be "an occupational therapist or physical therapist with a current professional credential," licensed or certified for at least three years, with at least 4,000 hours of direct practice experience in hand therapy. Hours worked "as an occupational therapy assistant, physical therapist assistant or with a temporary license cannot be submitted." CHTs recertify every five years, per HTCC's recertification page.

What the CHT does do is unlock or shortcut state approvals in several places, which is why it matters for licensing even though it is not a license.

Which states require approval for hand therapy itself?

California is the clear case. An OT may perform hand therapy services there "only when an occupational therapist has demonstrated to the Board" that they meet its post-professional requirements (16 CCR § 4151):

• Education: 45 contact hours in the subjects the statute lists, including 30 hours specifically on the hand, wrist and forearm.
• Training: 480 hours of supervised on-the-job training, clinical internship or affiliation in hand therapy, paid or voluntary.
• CHT shortcut: an OT whose application shows "current certification as a Certified Hand Therapist" is "deemed to have met the education and training requirements."

The education and training must have been completed within the five years before you apply, and supervised training needs a written agreement signed by both parties before the hours start (16 CCR § 4154). You apply on the board's hand therapy form with certificates, syllabi for courses that are not board-approved, and supervisor-signed verification of hours; an application not completed within six months of receipt or a deficiency notice is treated as abandoned (16 CCR § 4155). This approval is separate from, and in addition to, the California license itself. See California's advanced practice approvals.

What about modalities in the hand clinic?

Modalities are where most states with extra rules focus.

• California: physical agent modalities need their own approval: 30 contact hours and 240 hours of supervised training, again with the CHT deemed to satisfy it (16 CCR § 4152). A hand therapist using modalities needs both approvals, though up to 8 contact hours and 60 training hours from the modality approval count toward hand therapy (§ 4151(c)).
• Tennessee: board certification is required to use electrical stimulation (25 contact hours including 5 supervised patient treatments) or thermal agents (20 contact hours including 10 supervised treatments, 5 of them ultrasound). Current HTCC certification substitutes for the training in both. Training must have been completed within two years before you apply (Tenn. Comp. R. & Regs. 1150-02-.04(4)).
• Florida: an OT or OTA may use a prescription electrical stimulation or ultrasound device only after at least 4 hours of didactic training and 5 supervised treatments for each, and the rule names the American Society of Hand Therapists among acceptable training sources (Fla. Admin. Code R. 64B11-4.001).

More states are covered in physical agent modality rules for OTs by state.

Does the CHT matter for dry needling?

In Maryland it is the gate. Maryland's rule limits dry needling by OTs to "occupational therapists who are certified hand therapists," requires 52 hours of further instruction (27 in specific content areas and 25 hands-on under a supervisor with five years of dry needling practice), two years of OT practice in addition to the CHT, and registration with the Board. Keeping that registration requires proof of CHT recertification (COMAR 10.46.09). Florida and Tennessee allow OT dry needling on other terms that do not require the CHT. See dry needling and occupational therapy.

Do the approvals follow you to a new state?

No. A California hand therapy approval, a Tennessee modality certification or a Maryland dry needling registration is tied to that state. In the new state, the question is whether it has its own approval and, if so, whether your CHT or prior training satisfies it. California and Tennessee both accept the CHT in place of their training hours, which makes the CHT the most portable proof a hand therapist has.

A compact privilege does not change this. Under the OT Compact, a privilege holder "shall function within the laws and regulations of the Remote State" (Section 4.C). California is not a compact member, but Tennessee and Maryland issue privileges, so an OT practicing there under a privilege still needs the state's modality certification or dry needling registration where the rules require one. Ask the board how a privilege holder applies.

What should a hand therapist check before moving?

1. The license route: endorsement, or a compact privilege if both states issue them.
2. Whether the state requires approval for hand therapy, modalities or dry needling.
3. Whether your CHT satisfies that approval, and what proof the board wants (usually a current certificate).
4. Your CHT recertification date, since approvals that rely on it may lapse with it.
5. Whether OTAs in your clinic can apply the modalities under that state's supervision rules.

How do we help hand therapists?

We file the license first (License by Endorsement, $599 per state, or a Full State License Application, $749, for California and other states that review the whole file), then the advanced approvals. Our California Advanced Practice Approval is $349 per area: we assemble your CHT proof or your education and supervised hours and file the board's form. Board fees are separate, and we do not provide or certify training. State requirements are in the license index.