The first national occupational therapy licensing examination was administered by the National Institute of Health in 1965. In 1998, National Health Personnel Licensing Examination Board assumed responsibilities for the development, administration, and implementation of the licensing process based on current and valid standards for occupational therapy practice. The purpose of awarding license is to identify for the public those persons who have demonstrated both the knowledge and the skills necessary to provide occupational therapy service. As an effort to develop, maintain, and defend the content validity of practice-based occupational therapy licensing examination, National Health Personnel Licensing Examination Board sponsored and authorized the occupational therapy practice analysis study in 2000. Based on the occupational therapy practice analysis study, Minimum Standards for the Education of Occupational Therapists By World Federation of Occupational Therapists, and The National Occupational Therapy Practice Analysis in the USA, this article points out several problems concerning the existing national occupational therapy licensing examination and suggests the alternatives that reflect current professional practice.