How to Value an Occupational Therapy Practice

Occupational therapy practices are one of the most under-discussed segments in healthcare M&A, which means owners often have no idea what their practice is worth when they start thinking about an exit. I've valued OT practices ranging from a solo pediatric therapist in a 1,200-square-foot clinic to a 14-location multi-discipline rehab platform with 60+ therapists. The valuation range is enormous, and the drivers are specific to this specialty.

The Valuation Framework

OT practice valuations break into two tiers based on size and structure:

• Single-location, owner-operator practices: 3-5x SDE, or roughly 50-70% of annual revenue. These are typically pediatric-focused or hand therapy clinics with 2-6 therapists where the owner is still treating patients.
• Multi-site practices with management layer: 5-8x EBITDA. Once you have 3+ locations, 10+ therapists, and a clinic director who isn't the owner, you're in institutional buyer territory.

The jump from SDE-based to EBITDA-based valuation is significant. A solo OT generating $600K revenue with $250K SDE sells for $750K-$1.25M. A four-location practice generating $3M revenue with $500K EBITDA sells for $2.5M-$4M. The math strongly favors building scale before selling.

Pediatric OT: The Fastest-Growing Segment

Pediatric occupational therapy is where the growth is, and acquirers know it. Autism spectrum disorder diagnoses have increased to approximately 1 in 36 children (CDC, 2024), up from 1 in 44 just two years prior. Every one of those diagnoses typically generates referrals for OT evaluation and ongoing treatment for sensory processing, fine motor development, and daily living skills.

Pediatric OT practices command premium valuations within the OT space for several reasons:

Reimbursement rates are higher. Pediatric OT CPT codes — particularly sensory integration therapy (97530), therapeutic activities (97530), and neuromuscular re-education (97112) — reimburse at $80-$150 per unit depending on payer and geography. Compare that to adult rehab where many codes reimburse at $60-$100. A pediatric OT seeing 8 patients per day at $150/session generates $1,200/day vs. $800-$960 for a typical adult OT caseload.

Treatment duration is longer.A child with autism or sensory processing disorder may receive OT services for 2-5 years, attending 1-2 sessions per week. That's 100-500 visits per patient over the treatment course. Adult orthopedic OT cases typically run 8-16 visits. Longer treatment relationships mean more predictable revenue.

Waitlists signal demand. Many pediatric OT practices have 3-6 month waitlists, which is both a constraint and a powerful signal to buyers. A practice with a 200-child waitlist is essentially sitting on $400K-$800K in unrealized annual revenue that a buyer can capture by adding therapists and space.

Hand Therapy: The Specialist Premium

Certified Hand Therapists (CHTs) are among the most valuable individual practitioners in outpatient rehab. The CHT certification requires 4,000+ hours of direct hand therapy experience and passage of a rigorous exam — there are only about 7,500 active CHTs in the US. That scarcity drives economics.

A CHT bills at higher rates than a general OT: $120-$200 per visit vs. $80-$130 for standard OT treatment. Hand therapy patients are often workers' compensation cases (higher reimbursement, faster payment) or surgical post-op cases referred directly by orthopedic and hand surgeons. A single CHT generating $300K-$450K in annual collections is common.

Practices with CHTs on staff command a 15-25% valuation premium because the certification is difficult to replace. If a CHT leaves, it takes 12-18 months to recruit a replacement, and the referral relationships with surgeons may not transfer. Buyers pay more but also conduct heavier diligence on CHT retention — expect questions about employment agreements, non-competes, and compensation structure.

A dedicated hand therapy clinic with 3 CHTs, $1.2M revenue, and $350K SDE recently sold for 4.5x SDE ($1.58M) to a regional rehab platform. The buyer's primary motivation was accessing the surgeon referral network and workers' comp payer relationships that came with the practice.

Key Valuation Metrics

When I evaluate an OT practice, these are the numbers I focus on:

Visits per therapist per day. The benchmark is 7-10 visits per full-time OT per day. Below 7 suggests scheduling inefficiency or weak referral flow. Above 10, and you need to examine whether documentation quality and treatment time are being sacrificed. Buyers model revenue as visits x rate, so visit volume is the top-line driver.

Revenue per visit.Ranges from $80 for Medicaid-heavy adult practices to $175+ for pediatric practices with strong commercial insurance mix. The national average for outpatient OT is approximately $110-$130 per visit. Practices significantly below this either have payer mix problems or aren't billing optimally.

Payer mix.Commercial insurance (50%+ is ideal), followed by Medicare Part B (declining reimbursement but stable volume), Medicaid (lower rates but growing pediatric volume), workers' compensation (high reimbursement, complex billing), and cash pay (growing, especially in pediatric sensory integration). Practices with 60%+ commercial payer mix get premium valuations.

Therapist retention rate. This is the silent killer in rehab practice valuations. OT turnover nationally runs 15-25% annually, driven by burnout, student loan burden ($80K-$150K for OTD programs), and competition for talent. A practice with 90%+ therapist retention over 3 years will get a meaningfully higher multiple than one losing a third of its staff annually. Buyers know that every departing therapist takes $200K-$350K in annual revenue with them.

Referral source diversification. Similar to physical therapy practices, OT practices dependent on a small number of referring physicians face concentration risk. If one pediatrician or one hand surgeon represents 25%+ of your referrals, buyers will discount accordingly. Healthy practices have 30+ active referral sources with no single source above 10%.

Multi-Discipline Practices: OT + PT + Speech

Many OT practices, especially in pediatrics, operate as multi-discipline clinics offering OT, physical therapy, and speech-language pathology under one roof. These integrated practices command higher valuations — typically 10-20% above single-discipline equivalents — because they offer buyers a more complete service platform.

The economics are compelling. A child diagnosed with autism typically needs OT (sensory and fine motor), speech therapy (communication), and sometimes PT (gross motor). A multi-discipline practice captures 2-3 visits per week from one patient instead of one. If the family is already coming to your clinic for OT, adding speech means $400-$600 per week in additional revenue per patient with minimal incremental marketing cost.

The acquirer landscape for multi-discipline pediatric rehab includes Therapy Brands (PE-backed), Centria Healthcare (focused on autism services), and several regional platforms building scale in the pediatric therapy space. A 5-location pediatric OT/speech practice with $4M+ revenue and $600K-$800K EBITDA would attract legitimate interest from these buyers at 6-8x EBITDA.

What Buyers Pay and Why

The buyer pool for OT practices breaks into three tiers:

• Individual OTs buying a practice: Pay 3-4x SDE. They're buying a job and a patient base. Financing through SBA 7(a) loans, which cap acquisition multiples informally around 3-4x because of debt service coverage requirements.
• Regional rehab platforms: Pay 4-6x EBITDA. These are multi-location PT/OT groups adding geography or specialty capabilities. They have management infrastructure to absorb a practice without the selling owner.
• PE-backed therapy platforms: Pay 5-8x EBITDA for practices that fit their model. They're buying EBITDA to add to their platform, and they value predictability above all else. Select Medical, Athletico, and US Physical Therapy (now Graham Healthcare Group) are public comparables; private platforms often pay similar or higher multiples for acquisition targets.

The Bottom Line

OT practice valuation in 2026 is driven by three factors above all else: population served (pediatric commands premiums), practice scale (multi-site unlocks institutional buyers), and therapist stability (retention is the leading indicator of sustainable revenue). If you're an OT practice owner planning an exit, invest in retaining your therapists, building your pediatric or hand therapy specialization, and expanding to multiple locations. The difference between a 3x SDE exit and a 7x EBITDA exit can easily be seven figures.