Occupational therapy practices

The company shape

US outpatient occupational therapy is a $5.5 billion category with roughly 145,000 licensed OTs and 65,000 certified occupational therapy assistants (COTAs). The category is fragmented across settings: pediatric clinics (developmental delays, autism spectrum, sensory processing, feeding), adult and geriatric clinics (post-stroke, hand therapy, cognitive rehab, activities of daily living), hand therapy specialty clinics (CHT certification, post-orthopedic surgery, repetitive strain), and school-based or early intervention contracts. Outpatient OT sits inside physical therapy groups at some scale and stands alone in others.

Revenue bands. Solo OT clinic with one to two treatment rooms, 2 to 4 staff: $350K to $900K in annual collections. Small pediatric group with sensory gym, 3 to 8 OTs and COTAs: $1M to $3.2M. Multi-location pediatric or adult group at 4 to 12 clinics: $3.5M to $14M. Large regional or national platform (Kids First, Ivy Rehab Pediatric, Bright Horizons Pediatric Therapy, All About Kids): $18M to $150M with 30 to 500+ clinics.

Pediatric OT is the dominant subset by clinic count. Pediatric practices treat sensory processing, autism-related occupational goals, developmental coordination disorder, handwriting, feeding, self-regulation, and school readiness. Reimbursement mix is commercial insurance (55 to 70 percent), Medicaid or state-funded early intervention (15 to 30 percent), private pay and financial assistance (5 to 15 percent). Session pricing runs $110 to $220 for evaluation and $95 to $175 for treatment.

Hand therapy is the highest-margin adult subset. Certified Hand Therapists (CHT) treat post-surgical hand and wrist cases (carpal tunnel release, trigger finger, distal radius fracture, tendon repair, joint replacement), overuse injuries, and complex chronic conditions. Referral pipelines run through orthopedic and plastic surgery. Session pricing $135 to $260 with strong commercial reimbursement.

Adult and geriatric OT typically sits inside hospital-based outpatient rehab or PT groups. Standalone adult OT clinics exist but are less common. Post-stroke rehab, cognitive rehabilitation, low vision OT, and driver rehabilitation are the growth subsets.

Owner economics track service mix and payer mix. A well-run pediatric clinic at $1.2M in collections nets $200K to $320K to the OT-owner. A well-run hand therapy specialty at the same top line nets $280K to $420K because reimbursement is higher and staffing ratios are leaner. Marketing strategy has to reflect which segment the practice is defending and which segment offers growth.

The buyer

Occupational therapy buyers vary by subset. Pediatric OT has two buyers who both matter: the parent (functional decision-maker, high emotional involvement, researches heavily) and the referring provider (pediatrician, developmental pediatrician, ABA provider, school psychologist, neuropsychologist). Adult OT has three buyers: the patient, the referring physician (typically orthopedic or neurology), and the case manager (for workers-comp or motor vehicle cases). Hand therapy has one buyer that dominates: the referring hand surgeon.

Pediatric parents are high-research, high-anxiety buyers. A child's diagnosis of sensory processing disorder or autism spectrum triggers 30 to 90 days of parent research before booking evaluation. Parents Google specific conditions ("sensory processing disorder therapy," "OT for autism," "handwriting help for kids," "picky eater feeding therapy"), read blogs, join Facebook groups, and cross-reference reviews. Practices with real condition content written by an OT, honest evaluation and treatment expectations, and warm intake experiences capture this segment.

Pediatric referring providers include pediatricians (routine referral for developmental delay), developmental pediatricians (autism and complex cases), ABA providers (co-treatment coordination), school psychologists (educational and functional support), and neuropsychologists. Practices that maintain relationships with 15 to 30 referring providers in the market, and return evaluation summaries to referrers within a week, hold the pipeline.

Hand therapy referring surgeons are the primary buyer. Orthopedic hand surgeons and plastic surgeons refer post-surgical cases within 24 to 72 hours of surgery. The relationship forms early and calcifies. Surgeons choose hand therapy based on CHT credential, communication discipline, protocol adherence to their surgical technique, and patient reports of experience. A single dropped ball on scheduling or a poorly executed splint can end a surgeon referral relationship.

Adult and geriatric OT patients often arrive through hospital discharge planners, primary care referral, or self-search after a stroke or fall. Home health OT operates in a different sales motion (agency contract, not consumer marketing) and is not covered here in depth.

Decision drivers across segments: OT credentials (COTA, OT, OTR/L, CHT certification, specialty training in Sensory Integration Certification, DIR/Floortime, SOS Approach to Feeding, NDT), insurance and Medicaid acceptance clarity, sensory gym or hand therapy equipment visible on the site, evaluation and treatment expectations content, and reviews with condition-specific detail.

Seasonality varies. Pediatric evaluation volume peaks September (back-to-school realization of gaps) and January (new insurance year and post-holiday reset). Hand therapy volume is roughly flat with mild summer peak (activity-related injuries).

Discovery landscape

First-touch attribution splits sharply by subset. Pediatric OT typical mix: Google Business Profile 20 to 28 percent, Google organic 22 to 32 percent (highest of any healthcare subset because parents research conditions heavily), physician and school referral 22 to 32 percent, Facebook groups and community referral 8 to 15 percent, Google Ads 6 to 12 percent, Instagram 3 to 8 percent. Hand therapy typical mix: physician referral 55 to 70 percent, Google Business Profile 15 to 22 percent, Google organic 8 to 14 percent, Google Ads 3 to 8 percent.

Of the 13 Ranking Surfaces, seven move revenue for pediatric OT. SEO leads because parents research conditions before booking. LSO is second. E-E-A-T is heavily weighted because pediatric care is YMYL and parents scrutinize OT credentials. AEO for condition and therapy-approach queries. GEO extends AEO. CWV. VxSO for sensory gym and treatment approach photography.

For hand therapy the mix flips. Physician referral outweighs any search surface. LSO and SEO still matter but the growth-lever activity is business development to referring surgeons. Marketing that fails to invest in surgeon relationship maintenance underperforms even with a perfect SEO stack.

Facebook groups are an underrated discovery channel in pediatric OT. Local parent groups (special needs communities, autism family groups, sensory processing groups) exchange recommendations heavily. Practices that build real relationships with these communities (education content, free workshops, community events) receive word-of-mouth referrals at higher conversion rates than any paid channel.

School-based referral is a distinct channel with its own dynamics. Practices that maintain relationships with school psychologists, occupational therapists in the school district, and special education coordinators capture inbound tied to IEP recommendations that parents then act on privately.

Five surfaces do not move volume meaningfully. VSO at low volume. ASO applies only at platform scale. KGO rare. GLOBO. Web3. AAO is not yet producing volume but llms.txt v2 is worth setting up because parents increasingly query AI for condition research.

What breaks most often

Seven failure modes recur.

Site written for clinicians instead of parents. Pediatric OT sites overuse professional jargon (proprioception, vestibular processing, praxis, bilateral coordination) without translation. Parents Google plain-language symptoms ("my kid melts down in loud places," "my child can't hold a pencil right"). Sites that answer the parent's actual question in the parent's language and then bridge to clinical terminology capture research-window traffic.

No per-condition or per-approach pages. Parents search sensory processing disorder, autism-related OT, ADHD OT, DCD, feeding therapy, handwriting help, and specific approaches like DIR/Floortime, SOS Approach to Feeding, sensory integration. Practices with a single "pediatric OT" page cannot rank for any of these queries. Practices with 15 to 25 per-condition and per-approach pages capture the long tail.

Insurance and Medicaid clarity buried. Pediatric OT is often blocked by insurance authorization uncertainty. Practices that publish clearly which commercial carriers they accept, which state Medicaid plans, and how private-pay pricing works reduce booking friction meaningfully.

Sensory gym and equipment invisible. Parents choose pediatric OT partly on the visible environment. Practices that publish photos and descriptions of the sensory gym, swings, climbing wall, tactile area, and quiet spaces convert visitors better than practices showing only exterior photos.

Hand therapy CHT credential underused. Certified Hand Therapist is a real market signal. Practices with CHTs on staff often bury the credential in a paragraph bio. Practices that build a hand therapy landing page with CHTs named, prominent credential display, common conditions treated, and surgeon partnership language capture inbound and reinforce surgeon confidence.

Reviews sparse or condition-generic. A pediatric OT clinic sees 40 to 100 families a month and gains 2 to 4 Google reviews. Systematic review generation via post-session SMS or in-clinic tablet produces 15 to 35 reviews per month. Reviews with condition-specific detail help parents comparing practices.

Physician liaison motion absent for hand therapy. Hand therapy practices without regular in-person outreach to referring hand surgeons cede referral flow to whichever practice sends a friendly note first. Monthly cadence with 8 to 15 surgeons, clean protocol communication, and shared outcomes reporting hold the pipeline.

The Ranking Surfaces Playbook applied

Tier one: revenue this quarter

SEO. Per-condition and per-approach grid for pediatric (SPD, autism, ADHD, DCD, feeding, handwriting, self-regulation, motor planning, DIR/Floortime, SOS Approach, sensory integration certified therapist). Per-condition grid for hand therapy (carpal tunnel, trigger finger, distal radius, tendon repair, arthritis, De Quervain's, TFCC, complex regional pain syndrome). Per-city pages. LocalBusiness plus MedicalBusiness schema. FAQPage schema on evaluation, insurance, and treatment expectations.

LSO. GBP rebuild with primary category "Occupational therapist" and secondaries for "Children's health service center," "Rehabilitation center," or "Physical therapy clinic" as appropriate. Precise service area. Weekly Posts alternating condition explainers, therapist spotlights, sensory gym content, community events. Systematic review generation via post-session SMS.

E-E-A-T. OT bios with real photo, university, year of graduation, specialty certifications (SIPT, SOS, DIR, NDT, CHT for hand), continuing education, state license. Practice ownership and philosophy of care disclosed. Named About page.

Tier two: compounds

AEO. Direct-answer guides on 25 to 40 condition, approach, and cost queries. TL;DR opener, FAQPage schema, honest evaluation and treatment timelines. Guides bylined by an OT.

GEO. Organization plus MedicalBusiness schema. sameAs to GBP, AOTA state association, NBCOT profile, LinkedIn, Facebook. llms.txt v2 in place.

CWV. LCP under 2s. Mobile-first because parents research on phones.

Tier three: lower ROI, low cost

VxSO. ImageObject schema on sensory gym, treatment approach, and hand therapy equipment photos. Descriptive alt text.

VSO. Speakable markup on FAQ blocks.

Tier four: not a fit

ASO (unless platform scale). KGO, GLOBO, Web3. Skip AAO for now, prepare llms.txt v2 as first-mover.

How Playbook priority shifts by practice size and subset

Solo pediatric $350K to $900K: SEO plus LSO plus a parent-language site with top 8 condition pages, insurance clarity, sensory gym imagery, OT bios. Small pediatric group $1M to $3.2M: full SEO grid, per-therapist bios with specialty focus, community engagement content, AEO on top 15 queries, Facebook group and school district relationship building. Hand therapy specialty: surgeon-relationship-first with SEO and LSO as supporting infrastructure. Multi-location $3.5M to $14M: full Playbook subset, per-clinic GBP with per-OT attribution, cross-location content. Platform scale: multi-metro measurement, brand SEO, ASO for parent portal.

First 30 / 60 / 90 days

Days 1 to 30

Attribution baseline. Cost per evaluation by channel, evaluation-to-treatment conversion rate, average visits per episode, and payer mix. GBP rebuild with correct primary and expanded secondaries. Insurance and Medicaid list published clearly. Sensory gym photographed for the site. Review generation flow live via post-session SMS with GBP link. OT bios written and published with real credentials. Weekly reporting on evaluations, conversion, visits per episode, review count, and revenue by segment.

Days 31 to 60

Site restructure. First 10 per-condition and per-approach pages built in parent language with OT byline. Sensory gym and clinic environment photography. Hand therapy landing page if applicable with CHTs named. HIPAA-compliant patient story process. CWV in green. Google Ads restructured into condition-and-approach campaigns with tight negatives (remove "OT school," "OT salary," and general career queries). First 6 AEO guides on the highest-intent parent and referring-provider questions.

Days 61 to 90

Referral and community activation. In-person outreach to 15 to 30 pediatricians, developmental pediatricians, school psychologists, and ABA providers. Hand therapy practices activate surgeon liaison motion with monthly cadence to 8 to 15 surgeons. Facebook group and local special-needs community engagement started. Twelve AEO guides live cumulative. Rank tracking on condition-and-city terms. First map-pack gains between day 60 and day 90. Realistic year-one outcomes: 25 to 45 percent lift in evaluations, evaluation-to-treatment conversion up 5 to 10 points, and payer mix improving toward higher-margin commercial cases.

Measurement stack across the 90-day window

GA4 with events for evaluation_request, condition_page_view, phone_call, form_submit. CallRail with unique numbers per channel. Practice management software (WebPT, ClinicSource, Fusion Web Clinic, Practice Perfect) with contact source, condition, and episode length tagged. Weekly dashboard covering evaluations by channel, conversion rate, visits per episode, review count, and revenue by service line. Cost caps: paid media at 4 to 7 percent of trailing collections. SEO and content at 1 to 2 percent. Review management software at $150 to $500 per month.