If you are a Occupational Therapist or Occupational Therapist Assistant, and you have undergone a legal name change via marriage, divorce or otherwise, please be advised that in order for the Board to change the name in which your OT or OTA license is issued, you are REQUIRED to submit the following:
- completed name change request form
- a certified marriage certificate specifying the name change following marriage; or
- a certified divorce or dissolution of marriage decree specifying the name change (send only the first page, the page indicating the name change, and the signature pages); or
- other certified court order specifying the name change.
Please do not submit foreign marriage certificates that do not reflect your name change following marriage, as the Board is unable to accept them for purposes of changing your name on your license.
Licensees must notify the Board of a name change within 30 days of the change event.