Introduction: Investigation on spiritual issue in healthcare practice received less attention. Muslims valued pray activity or known as salat as one of the important daily activity. However, negligible study is available on salat as the end goal of occupational therapy intervention. This study aims to investigate the awareness and the impact of Muslim-culture on occupational therapists in Malaysia. Methods: A cross-sectional survey study was conducted via internet-based and manual paper-and-pencil survey throughout occupational therapists in Malaysia. Descriptive and inferential statistics using percentage, Cronbach’s alpha and Chi-square was implemented on the findings. Results: In total, 119 occupational therapists responded. The questionnaire has overall internal consistency ofα = 0.74. Occupational therapists have positive perceptions on spiritual activity but poorly translated into service implementation and faced challenges. Factors such as level of education, years of experience, religion, working location and work setting were significant on the awareness, perception, practice and challenges. Cultural-based practice is challenging for occupational therapy even in the majority-practice context. Occupational therapists should differentiate between belief and activity in spiritual issue to provide a better assistance for the clients. Conclusion: This study showed continuing education is desired to drive the occupational therapy profession for a better cultural-sensitivity service delivery.