License Conversion Form

All sections of the form are mandatory and must be completed. Incomplete forms will not be accepted and will be denied. If you wish to convert a retired license, please contact the board office at (775) 746-4101 for payment instructions.


OT Convert Inactive Status to Active Status Fee: $150.00	OTA Convert Inactive Status to Active Status Fee: $100.00
OT Convert Temporary License Fee: $150.00	OTA Convert Temporary License Fee: $125.00
OT Convert Provisional License Fee: $150.00	OTA Convert Provisional License Fee: $125.00

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Last Name	Last 4 Digits of SSN	License Number