Aims To (1) characterize early therapy services for preterm infants in the first two years of life, and (2) define factors related to accessing early therapy services. Methods Therapy utilization after discharge from the neonatal intensive care unit (NICU) was tracked in 57 infants born ≤30 weeks gestation from 2007 to 2010. Participants returned for developmental testing at two years. Factors related to early therapy utilization were explored. Results Fifty-two (91%) infants received a referral for therapy at NICU discharge but only 44 (77%) received at least one type of therapy during the first two years of life. Infants who received early therapy services were more likely to have more days on ventilation (p = .005), have single mothers (p = .047), and exhibit abnormal neurobehavior at term equivalent age (p = .03). On average, infants first received occupational therapy at a mean age of 5.1±4.6 months with a median of 2.6 (1.3–9.0), physical therapy at a mean age of 4.3 ± 4.1 months with a median of 3.7 (0.1–5.5), and speech-language pathology services at a mean age of 14.0±6.1 months with a median of 15.0 (11.3–17.7) months corrected age. Of the 13 children who did not receive any therapy in the first two years after NICU discharge, seven (53%) had a developmental delay at an age of two years. Conclusions In spite of high referral rates for therapy services, there is a delay in therapy activation following NICU discharge, and some infants who warrant services do not obtain them.