Little is known about characteristics and driving patterns of drivers with physical disabilities who use vehicle modifications (VMs). We gathered information about, and from, drivers with disabilities who use VMs to better understand their needs and to inform current occupational therapy driver rehabilitation practice. A prospective descriptive cross-sectional analysis of 97 drivers with physical disabilities who used VMs identified that most participants were dependent on wheelchairs for personal mobility and that access to key destinations without independent driver mobility was difficult or impossible. Personal independence facilitated by VM use enhanced community participation, including access to health care and employment. Slightly more than half the surveyed drivers (51%) obtained occupational therapy services for driver assessment and VM evaluation. Participants reported VM safety and maintenance issues, including difficulties obtaining appropriate VMs. Study results highlight the potential value of occupational therapy driver assessments and the need for postimplementation review of VMs.