Pi Theta Epsilon began at the University of New Hampshire in the fall of 1958. In 1987, the American Student Committee of the Occupational Therapy Association (ASCOTA), now the Association of Student Delegates (ASD), surveyed existing chapters about standards to establish and maintain a national honor society. In 1988, the Board of Directors of the American Occupational Therapy Foundation agreed to provide sponsorship and assistance in achieving recognition as a national honor society. An advisory committee was established and an operating budget was provided to support Pi Theta Epsilon activities through 1994. Work was undertaken to increase the number of chapters, register a logo, and become recognized by the Association of College Honor Societies (ACHS). By March 1995, there were 43 operational chapters in the United States. In 2008, the AOTF Bylaws were amended to include the PTE president as a voting member of the Foundation Board of Directors. There are currently over 90 active chapters.
Pi Theta Epsilon is governed by a Constitution that is upheld by elected officers who constitute a national executive committee. The annual meeting of chapter delegates is held at the AOTA Annual Conference.