Does an occupational therapist from Saint-Alphonse-de-Granby meet the TN profession requirement without an American state licence in hand?

The treaty entry and the right to practise are different tests. Hypothetical example: Marilou is a Canadian citizen working as an occupational therapist here, and an American rehabilitation group has offered her a clinical post. Occupational Therapist appears in Appendix 2 with its own rule, met by a baccalaureate degree or by state or provincial licensure, so Marilou's credentials can satisfy the immigration question. Whether she may lawfully treat patients is decided by the state board, and no admission decision supplies that authority.

One word, two regulators, and only one of them is at the border

Three findings have to line up. Marilou must be a citizen of Canada or Mexico; permanent residence would not do, and that point is checked from a passport rather than from a card. The occupation must appear on the treaty list, which Occupational Therapist does, and she must satisfy that entry's own credential rule.

Finally, the American position must itself require and consist of that professional work. Where the entry is written to accept licensure, an officer may accept a provincial permit as evidence of qualification even though it grants no authority in the United States. The practical consequence is unpleasant if the two are confused: an applicant can be admitted and then discover that the employer cannot roster her, the insurer will not cover her, and the assignment stalls while an unrelated regulator processes an application she should have started months earlier.

Sequence the state file first and the immigration question second.