IN THIS GUIDE · A licensed rehabilitation profession, where the American state licence has to exist before the treaty profession is even reached
Start with the TN eligibility and application overview
The state licence and the treaty profession are two separate hurdles in one word
Appendix 2 defines several health professions by reference to licensure, which creates a confusing overlap. The treaty entry asks whether Marilou personally meets the profession's own credential rule. Practising in an American state asks a different question, answered only by that state's regulator, and it commonly involves verification of her Quebec education, an examination record, jurisprudence testing and a processing period measured in months rather than weeks. An officer deciding admission is concerned with the first question. A hospital's credentialling department, a malpractice insurer and the state board are concerned with the second. Both must be satisfied before she can lawfully do the work, and only one of them is decided at the border. Treating them as a single step is how people arrive with authorization to enter and no authority to treat anyone.
What the title clinical program lead has to contain to remain a therapy job
The classification follows the duties, so the phrase on the offer letter settles nothing by itself. Assessment, treatment planning, functional evaluation, adaptive equipment prescription and supervision of therapy delivered to named patients are occupational therapy. Building referral relationships with discharge planners, negotiating with payers, recruiting therapists and running a caseload calendar are administration, and a week composed mostly of those activities describes a manager rather than a therapist. Marilou should ask the group for a written split of her time by activity before anything is signed. If the group genuinely wants an administrator, the honest answer is that this route does not fit and another category has to be examined. If it wants a senior clinician who also coordinates, the letter should say that in those proportions.
Invoicing through her Quebec corporation would end the application, not bridge it
Self-employment in the United States is not permitted on this route, and an arrangement in which the American group pays Marilou's Quebec company for her services is exactly the arrangement the rule is aimed at. The proposal usually appears for innocent reasons, such as a payroll system that cannot enrol her until a licence number exists. It remains fatal. She must be employed by, or under contract to, an American entity that directs her work and carries the ordinary obligations of an employer. Her twenty per cent interest in the Quebec clinic is not disqualifying by itself, but it should be disclosed and reviewed, because any equity she is later offered in the American group would raise the question of whether the relationship is employment at all.
Sources reviewed 2026-09-07. This guide covers a preparation focus; it is not an individual eligibility assessment.
- USCIS: TN NAFTA Professionals
- U.S. Department of State: USMCA professional workers
- Department of State: 9 FAM 402.17, TN and TD guidance
- eCFR: 8 CFR 214.6, Citizens of Canada or Mexico seeking temporary entry as business persons
- USCIS: Form G-1055, Fee Schedule
- USCIS translation requirement, 8 CFR 103.2(b)(3)