License pending, a job start date, and an out-of-state telehealth patient
A recent OT graduate in Albuquerque passed the NBCOT exam in June and submitted a New Mexico license application, but the Board has not issued a license because one transcript is missing. The rehabilitation director schedules her to start Monday, saying she can work as an 'OT under supervision' and bill insurance as an OT because a licensed OT will be in the building. The director also asks her to provide telehealth OT to a patient who lives in El Paso, Texas, while the therapist sits in New Mexico. The graduate has a job offer contingent on licensure and is worried about losing it. She has not been issued a temporary permit. The Texas patient has a prescription for OT after a wrist fracture.
1. Can the graduate begin treating New Mexico patients before the license is issued? What should she tell the employer?
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No independent practice without a license or Board-issued authorization. Passing NBCOT and submitting an application do not create practice authority. A licensed OT's physical presence does not convert an unlicensed graduate into a licensed OT or permit insurance billing under the OT's credentials. New Mexico law generally requires a license to practice and to use the title; any temporary, provisional, or graduate permit must be issued by the Board and may carry limits. The employer's 'under supervision' label is not a substitute for that authorization.
The graduate should decline to treat or bill until licensed. She can ask the employer to delay the start date, assign only non-clinical onboarding tasks consistent with state law, or confirm in writing whether the Board has issued any temporary authorization. She should not document as an OT, bill as an OT, or let the employer represent her as licensed. If the employer insists, she should escalate to HR or legal and preserve the written communications.
2. Does the New Mexico license authorize telehealth treatment of the patient in Texas?
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Telehealth licensure generally follows the patient's location. A clinician in New Mexico treating a patient physically located in Texas is usually practicing in Texas and needs Texas authorization, unless a specific interstate compact, emergency waiver, or Board rule provides otherwise. New Mexico licensure alone does not automatically authorize treatment of a Texas patient. The graduate should verify the Texas OT board's telehealth and licensure requirements rather than relying on the employer's assumption.
A prescription is not a license. The wrist fracture prescription establishes medical need but does not resolve the legal authority to provide OT. If the employer wants telehealth across state lines, the organization should confirm which clinician holds the required license and whether the patient must be seen by a Texas-authorized provider. The graduate should not provide the service until that is resolved in writing.
3. What should the graduate document and communicate to protect herself while awaiting licensure?
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Create a clear record of roles. She should keep copies of her application, any Board correspondence, and any written job offer or scheduling message. A short email to the director can state: 'I am not licensed in New Mexico yet and cannot treat or bill as an OT until the Board issues a license or temporary authorization. Please confirm my start date and duties in writing.' That is professional, not insubordinate.
Avoid credential misrepresentation. She should not sign notes with 'OTR/L' or 'OT' if not licensed, and she should not allow a supervising OT to co-sign as though that cures the lack of a license. If she observes billing for services she did not lawfully provide, she should report it through compliance channels.
Plan for the Texas request separately. For the El Paso patient, she should ask whether the patient is considered located in Texas and whether she holds or can obtain Texas authorization. Until then, the service should be reassigned to an appropriately licensed clinician.