In order to perform dry needling, an occupational therapist shall be a certified hand therapist in good standing, in addition to having completed at least 52 total hours of further instruction, which includes: A total of at least 27 hours of instruction in the following dry-needling-specific course content areas: Theory and application of dry needling to the hand, wrist, elbow, and shoulder; Dry needling technique to the hand, wrist, elbow, and shoulder; Dry needling indications and contraindications; Infection control, the Occupational Safety and Health Administration’s Bloodborne Pathogen Protocol, and safe handling of needles; Emergency preparedness and response procedures related to complications associated with dry needling; and Appropriate documentation of dry needling; and At least 25 hours of practical, hands-on instruction in the application and technique of dry needling, under the supervision of a licensed health care practitioner competent in dry needling procedures who has: Completed the requisite course work under §A(1) of this regulation; and Practiced dry needling for at least 5 years. The instruction required under §A(1) of this regulation shall be provided by a continuing education course approved by the Board. All instruction required under this regulation shall include an assessment of competency. The instruction required under §A(1) of this regulation shall be offered: In person at a face-to-face session; or In real time through electronic means that allow for simultaneous interaction between the instructor and the participants. An occupational therapist may not fulfill any portion of the practical, hands-on instruction required under §A(2) of this regulation with online or distance learning. An occupational therapist shall have practiced occupational therapy for at least 2 years, in addition to having been certified as a hand therapist, before performing dry needling in the State. Registration. An occupational therapist shall be registered with the Board as having the appropriate education and training required by this regulation to be approved to practice dry needling. In order to be registered to practice dry needling, an occupational therapist shall submit a completed application on a form supplied by the Board with proof of the hand therapist certification. In order to continue to practice dry needling, an approved occupational therapist shall submit proof of their certified hand therapy recertification. An occupational therapist who practices dry needling without the education and training required by this regulation shall be subject to discipline pursuant to COMAR 10.46.07.