Teachers must meet the educational needs of diverse students. Occupational therapists (OTs) assist some of these students through the provision of school-based occupational therapy (SBOT). However, there can be challenges to collaboration between OTs and teachers, and this can engender difficulty in achieving desired results. This scoping review was conducted to determine the tensions in collaborations between OTs and teachers in SBOT. The search strategy yielded 266 articles, of which 31 described tensions in collaboration. Forty-six unique tensions were identified in three categories: professional socialization, person-level tensions, and environment-level tensions. Possible actions for addressing the identified tensions are suggested.