License Applications
Physical Therapist and Physical Therapy Assistant Application, #08-4065, Revised 06/04/12.
Occupational Therapist and Occupational Therapy Assistant Application, #08-4123, Revised 06/04/12.
Physical Therapy and Occupational Therapy Limited Permit Application, #08-4578, Revised 06/04/11.
Foreign-Trained Physical Therapist and Physical Therapy Assistant Application, #08-4091, Revised 08/11/10
Renewal Applications
Renewal applications for the July 1, 2012 to June 30, 2014 licensing period were mailed on May 1, 2012. Plan 3 to 4 weeks for processing from the time you return your application. You will be contacted if your application is incomplete by US mail or E-mail if you provided an e-mail address.
Biennial Physical Therapist and Physical Therapy Assistant License Renewal, #08-4116, Revised 03/21/12.
Biennial Occupational Therapist and Occupational Therapy Assistant License Renewal, #08-4114, Revised 03/21/12.
Reinstatement Applications
Physical Therapist and Physical Therapy Assistant Reinstatement Application,
#08-4388, Revised 06/04/12.
Occupational Therapist and Occupational Therapy Assistant Reinstatement Application, #08-4570, Revised 06/04/12.
Miscellaneous Forms
Request for License Verification, #08-4222, Revised 11/28/07
Request for Duplicate Professional License, #08-0014,
Revised 06/11/07
Change of Name Form, #08-1431, Revised 04/20/09
Change of Address Form, #08-4291, Revised 04/20/09
Credit Card Payment Form, #08-4438, Revised 03/03/09
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