Introduction Occupation-based practice is a core tenet of occupational therapy. This study explores perspectives and experiences with occupation-based practice among Thai occupational therapists. Method Using mixed methods, a focus group was conducted with eight occupational therapists, and the results were interpreted using thematic analysis. A questionnaire survey was also completed concerning practitioner perspectives ( n = 216). Findings Three major themes were identified: (a) perspectives on occupation-based practice were related to practice areas and felt to strengthen the identity of occupational therapy (52% strongly agree), leading to improved services and better outcomes for clients (44% strongly agree); (b) approaches focused on activities of daily living were appropriate for cross-practice areas; and (c) occupation-based practice is consistent with integrated medical sciences and occupations for clients (52% strongly agree). Conclusion Implementing occupation-based practice will be of value to clients, provide benefits as a compass to direct processes, and enhance clinical reasoning and outcomes.