Beliefs about knowledge and knowing, also called epistemic and ontological cognition (EOC), are associated with many aspects of learning and achievement; no published studies have described the EOC of occupational therapy students. This study compares and contrasts occupational therapy students’ EOC at entry and on completion of didactic coursework. Twenty-one incoming and 33 postdidactic students completed the Epistemic Beliefs Inventory and the modified Four-Quadrant Scale and provided explanations for their self-ratings. Results indicate that the postdidactic students held more sophisticated stances toward occupational therapy–specific knowledge. The entering students demonstrated dogmatist and skeptic perspectives, with minimal evidence of a rationalist view of knowledge, whereas the postdidactic students showed evidence of primarily skeptic stances, with the emergence of rationalist views. Implications for occupational therapy theory, education, and research are discussed.