The COVID-19 pandemic changed the delivery of education as many occupational therapy (OT) programs temporarily transitioned to remote learning. The purpose of this article is to describe the impact of the COVID-19 pandemic on the National Board for Certification in Occupational Therapy (NBCOT) pass rates. A mixed methods research design was used consisting of quantitative data from all 35 OT programs from New York (NY), New Jersey (NJ), Connecticut (CT), and California (CA). Qualitative data was gathered from NY OT program graduates with fourteen convenience sampled graduate students who completed the qualitative survey. NBCOT exam scores from 2019-2021 were gathered for OT programs in NY, NJ, CT, and CA. A repeated-measures ANOVA and t-test were conducted to compare OT program performance on NBCOT exam. A qualitative survey was distributed via email to OT students who graduated in May of 2020. Results suggest a significant effect was found (F (3,99) = 2.946, p = 0.037). The decrease in passing scores occurred during the height of the pandemic in 2020 (M = 95.21, SD = 7.032), compared to the pre-pandemic period of 2019 (M = 97.41, SD = 3.016), and 'post-pandemic' period of 2021 (M = 97.44, SD = 3.661). The COVID-19 pandemic and the transition to online learning had a direct impact on OT student performance on the NBCOT exam. This study describes how pandemics, such as COVID-19, can affect student preparation for entry-level practice, while highlighting the need for institutional preparedness for future events.